1 

! 

RJ 

Si:':' 
9P'*:': 

61 

W4 

1921 

: 

BIOL 

i 


UC-NRLF 


1 


$B    17E    D35 


% 

ill 


m 

: 

:::::;:::: 

■ 

■::::•.  " 


m 


A 


GIFT  OF 


Digitized  by  the  Internet  Archive 

in  2007  with  funding  from 

Microsoft  Corporation 


http://www.archive.org/details/careinfantOOwestrich 


</ 


■\  v 


*&m 


U.  S.  DEPARTMENT  OF  LABOR 

JAMES  J.  DAVIS,  Secretary 

CHILDREN'S  BUREAU__^ 


GRACE  ABBOTT.  Chief 


rTJajE 


INFANT 


CARE  OF  CHILDREN  SERIES  No.  2 
Bureau  Publication  No.  8  (Revised) 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1921 


4\J&  s 


V 


SEE  THAT  THE  BIRTH  OF  YOUR  BABY  IS  REGISTERED. 

It  may  some  time  be  of  the  utmost  importance  to  your  child  that 
there  be  in  existence  an  accurate,  legal  record  of  its  birth  and  par- 
entage. It  would  be  well  to  ask  the  doctor  to  make  sure  that  your 
baby's  birth  is  properly  registered,  or  go  to  the  register's  office  your- 
self and  see  that  the  record  is  made.  It  is  suggested  that  a  memoran- 
dum be  made  below  of  certain  facts  recorded  in  the  birth  certificate. 

Baby's  name 

Father's  name 

Mother's  maiden  name 

Sex  of  baby 

If  twin  or  triplet,  give  number  in  order  of  birth 

Date  of  baby's  birth 

(Month.)  (Day.)  (Year.) 

Birthplace : 

City,  town,  or  village 

County . 

State 

Attending  physician : 

Name 

Address 

Baby's   registered  number 

2 


CONTENTS. 

Page. 

Letter  of  transmittal 9 

Birth  registration 11 

The  home 11-17 

Selecting  a  home 11 

The  nursery 12-17 

Temperature 12-13 

Winter 13 

Summer 13 

Ventilation 33 

Walls  and  floors 15 

Furnishings 15-17 

Bed 16 

Dressing  table 17 

The  care  of  the  baby 17-47 

Clothing  the  baby 17-23 

Diapers 18-19 

Care  of  the  diapers 18 

Waterproof  diapers 19 

Bands 19 

Shirts _—         20 

Petticoats 20 

Slips 20 

Night  clothing 20-21 

Sleeping  bags 21 

Shoes   and   stockings 21 

Cloaks  and  caps 22 

Additional  clothing  for  the  older  baby 23 

Baths  and  bathing 23-26 

Giving  the  bath 24-26 

Cool  bath 25 

Salt  bath a 26 

Starch  bath 26 

Soda  bath 26 

Bran  bath 26 

Sea   bathing 26 

Care  of  special  organs 27 

Eyes 27 

Mouth 27 

Ears - 27 

Nose 27 

Genital  organs 27 

3 

464972 


4  CONTENTS. 

The  care  of  the  baby— Continued.  Page. 

Sleep ._ 27-30 

Amount 27 

Additional  precautions 28-29 

In  winter 28 

In  summer 29 

Regularity 29 

Disturbed  sleep 29 

Teeth 30-32 

Deciduous  or  "  milk  "  teeth 31 

Growth _*_ 31 

Care 32 

Feet 32 

Development  of  the  normal  baby 32 

How  to  weigh  the  baby „ 33 

Outdoor  life " 34 

When  not  to  take  the  baby  out 34 

Exercise 34-36 

Creeping  pen 35 

Baby  pushers 35 

Vehicles 35 

Caution 36 

Playing  with  the  baby 37 

Toys 37 

Nursemaids '. 38 

Children  as  caretakers 38 

The  baby's  vacation 39-40 

Traveling  with  young  children 39 

Care  of  the  city  baby 40 

Care  of  the  country  baby 41 

Superstitions 41 

Habits,  training,  and  discipline 42-47 

Systematic  care 42 

Training  the  bowels 42 

Training  the  bladder 43 

Cleanly  habits 44 

Bad  habits 44-46 

Crying 44 

"Pacifiers"  or  "comforts" 44 

Thumb  or  finger  sucking 45 

Bed   wetting 45 

Masturbation 45 

Punishment 46 

Early  training 46 

Breast  feeding _ 47-62 

Importance  of  breast  feeding 47 

Production  of  breast  milk 48 

Care  of  the  nursing  mother 48-50 

Diet 48 

Bowels 49 

Baths 49 

Sleep 49 

Work 50 

Fresh  air  and  exercise 50 

Recreation 50 


CONTENTS.  5 

Breast  feeding — Continued.  Page. 

Care  of  the  breasts 50 

Technique  of  nursing i 52 

Feeding  rules 53 

Feeding  intervals 53 

Amount  of  food 53 

Growth 53 

Conditions  influencing  the  breast  milk 54-55 

Illness 55 

Menstruation 55 

Pregnancy 55 

Difficulties  of  the  nursing  period 55-57 

Stools 56 

Underfeeding 56 

Overfeeding 57 

Summary  of  feeding  for  a  well  breast-fed  baby 57 

Weaning 58-59 

How  to  wean 58 

Wet  nurses 59 

The  small  or  delicate  infant 60-61 

Premature   baby 60 

Expression  of  breast  milk 61 

Artificial  feeding £—  62-76 

Substitutes  for  mother's  milk 62-65 

Different  kinds  of  cow's  milk 63-64 

Raw  milk 63 

Pasteurized  milk 63 

Scalded  milk 63 

Boiled  milk 63 

Condensed  and  evaporated  milk 64 

Dry  milk  or  milk  powder 64 

Proprietary  infant  foods 64 

How  clean  cow's  milk  is  produced 65-66 

The  cow 65 

The  milker , 65 

Milking  utensils 65 

Refrigeration 66 

Choice  of  milk 66 

Care  of  milk  in  the  home . ». 66 

Preparation  for  artificial  feeding 67-69 

Equipment 67 

Preparation  of  the  bottle  feedings 68-69 

Bottles 68 

Nipples 68 

Sterilizing  utensils 69 

Mixing  the  food 69 

What  milk  mixture  to  feed  the  baby 69 

Milk 70 

Water 70 

Sugar 71 

Alkalies 71 

Additions  to  diet  under  1  year 71-72 

Starches i 71 

Fruit  juices 72 


b  CONTENTS. 

Artificial  feeding — Continued. 

Additions  to  diet  under  1  year — Continued.  Page. 

Vegetables 72 

Beef  juice 72 

Feeding  rules 72-73 

Feeding  intervals _ 72 

Amounts  at  each  feeding 73. 

Giving  the  bottle 73 

Growth 73 

Difficulties  of  the  artificially  fed  baby 74 

Stools 74 

Underfeeding 74 

Overfeeding 74 

Summary  of  artificial  feeding  to  1  year 74 

The  baby  from  1  to  2  years 76-79 

Food 76-78 

Milk '     77 

Starches 77 

Vegetables 77 

Eggs  or  meat 78 

Fruits 78 

Water 78 

Feeding  intervals 78 

Growth 78 

Summary  of  feeding,  14  months  to  2  years 78 

The  sick  baby 79-98 

What  a  mother  should  note 79 

Essentials  in  caring  for  a  sick  child 80 

Common  disorders  and  diseases  of  infancy 81-90 

Sudden  illness 82 

Vomiting 82 

Hiccough 82 

Colic 82 

Constipation 83 

Diarrhea 84 

Hot-weather  disturbances 85 

Scurvy 85 

Rickets 85 

Heat  rash 86 

Chafing .. 86 

Eczema 86 

Thrush 87 

Convulsions 87 

Worms 88 

Colds 88 

Adenoids 89 

Enlarged  tonsils 89 

Earache 89 

Croup 89 

Accidents 90-91 

Swallowing  foreign  bodies 90 

Swallowing  pills  or  poison 90 

Burns 90 

Inhaling  foreign  substances 91 


CONTENTS.  7 

The  sick  baby — Continued.  Page. 

Communicable    diseases 91-98 

How  to  prevent  the  spread  of  children's  diseases 91 

The  sick  room 92 

The  nurse 92 

The    patient 92 

Disinfecting  the  sick  room 92 

Whooping  cough 93 

Measles 93 

German  measles 94 

Scarlet  fever 94 

Chicken  pox 95 

Smallpox 95 

Diphtheria 95 

Infantile  paralysis 96 

Tuberculosis 97 

Gonorrhea 97 

Syphilis 97 

Food  recipes 99-105 

Buttermilk  and  whey 99 

Buttermilk 99 

Whey 99 

Cereals 99-101 

Cereal  water 99 

Gruels ^ 100 

Farina  gruel , 100 

Oatmeal  gruel 100 

Cornmeal  gruel 100 

Breakfast  cereals 100 

Proportions  and  time  for  cooking  cereals 101 

Breadstuffs 101 

Dried  bread 101 

Twice  baked  bread  (zwieback) 101 

Wafers   (plain) 101 

Bran    muffins 101 

Vegetables , 102 

Green  vegetables 102 

Starchy  vegetables 102 

Potato 102 

Rice 102 

Macaroni  and  spaghetti 102 

Vegetable  soup 102 

Meats 103 

Mutton  broth 103 

Scraped   beef 103 

Beef  juice 103 

Eggs 103 

Coddled  egg 103 

Scrambled  egg 103 

Fruits 104 

Stewed  prunes 104 

Apple  sauce * 104 

Baked  apples 104 


8  CONTENTS. 

Food   recipes — Continued.  Page. 

Desserts ' 104-105 

Plain  junket 104 

Custard   junket 104 

Boiled    custard 104 

Gelatin 105 

Cornstarch  pudding 105 

Cornstarch  fruit  jelly .    105 

Rice  pudding 105 

Prune  whip 105 

Government    publications 106 

Index 109 

RECORD  FORMS. 

See  that  the  birth  of  your  baby  is  registered 2 

Record  of  baby's  weight 107 

ILLUSTRATIONS. 

Position  of  teeth  in  the  mouth 31 

Expression  of  breast  milk Faces  page  62 


LETTER  OF  TRANSMITTAL. 


United  States  Department  of  Labor, 

Children's  Bureau, 
Washington,  July  27,  1921. 
Sir:  I  submit  herewith  a  revised  edition  of  the  bulletin,  Infant 
Care,  by  Mrs.  Max  West,  first  published  in  1914. 

Acknowledgment  is  hereby  made  of  aid  given  by  Mrs.  Max  West 
in  the  revision  of  the  general  sections  relating  to  infant  care  and 
by  Dr.  Dorothy  Reed  Mendenhall  in  the  preparation  of  sections 
on  infant  feeding.  Valuable  assistance  has  been  rendered  by  the 
bureau's  advisory  committee  of  pediatrists,  which  consists  of  physi- 
cians appointed  by  the  associations  which  they  represent :  Dr.  How- 
ard Childs  Carpenter,  representing  the  American  Child  Hygiene 
Association;  Dr.  Julius  Hess,  the  American  Medical  Association; 
and  Dr.  Richard  Smith,  the  American  Pediatric  Society. 
Respectfully  submitted. 

Julia  C.  Lathrop,  Chief. 
Hon.  James  J.  Davis, 

Secretary  of  Labor. 

9 


INFANT   CARE, 


BIRTH  REGISTRATION. 

It  is  of  the  utmost  importance  to  have  the  birth  of  the  baby- 
promptly  and  properly  registered.  This  should  be  done  preferably 
within  36  hours  after  the  baby's  birth. 

In  most  States  the  physician,  midwife,  nurse,  or  other  attendant  is 
required  by  law  to  report  the  birth  to  the  local  registrar,  who  will 
see  that  the  date  of  birth  and  the  child's  name,  together  with  other 
related  facts,  are  made  matters  of  public  record.  Birth  registration 
is  necessary  in  order  to  prove,  among  other  things,  the  child's  age 
and  citizenship,  his  right  to  go  to  school,  his  right  to  go  to  work,  to 
inherit  property,  to  marry,  to  hold  office,  to  secure  passports  for 
foreign  travel,  and  to  prove  his  mother's  right  to  a  pension,  if  she  is 
a  widow.  Parents  should  make  sure  that  this  protection  of  funda- 
mental rights  is  assured  to  every  child  born  to  them.  If  there  is  any 
doubt  about  whether  the  birth  of  a  child  has  been  registered,  an 
inquiry  may  be  sent  to  the  State  board  of  health  at  the  State  capital, 
where  the  records  are  filed.  If  there  is  no  birth  record,  the  board  will 
furnish  a  blank  which  may  then  be  filled  out  and  returned. 

THE  HOME. 
SELECTING  A  HOME. 

The  house  which  is  to  be  the  home  of  children  should  be  sunny, 
well  ventilated,  and  dry.  The  choice  is  usually  limited  by  the  size 
of  the  family  income,  but  there  is,  nevertheless,  within  this  limit 
some  range  of  selection.  Among  houses  of  the  same  rental  one 
may  be  in  better  repair  than  another,  or  the  houses  on  one  side  of 
the  street  may  be  sunnier  than  those  on  the  other,  or  one  house  may 
have  more  space  about  it  than  another,  or  the  plumbing,  drainage,  or 
other  conveniences  may  be  in  a  more  sanitary  condition  in  one  than 
in  another. 

Flats  and  apartments  do  not  usually  afford  enough  freedom  for 
growing  children,  although  a  baby  may  do  very  well  in  such  a  place 
until  he  is  2  or  3  years  old,  when  he  needs  more  room,  both  in- 
doors and  out.    Tenements  with  dark  rooms  are  not  fit  homes  for 

11 


12  *•:••*•«        •  / : « :*  infant  care. 

children**  « Sj&jirfcktt  'Honiesy  or •  those  in  the  outskirts  of  cities  or 
close  to*  pWbli'c'pai'lisjgiVe'to'city  children  of  the  average  family  the 
best  chance  for  proper  growth  and  development. 

In  selecting  a  city  home  it  is  wise  to  consider  what  possibilities  it 
has  for  future  improvement — as,  for  example,  whether  the  roof  can 
be  utilized  for  play  space,  whether  there  is  room  for  a  porch  or 
bay  window  on  any  side,  and  whether  the  back  yard  is  one  in  which 
the  children  may  play. 

In  smaller  cities,  towns,  and  rural  communities  it  is  easier  to  pro- 
vide children  with  light,  air,  and  out-of-door  space.  In  every  case 
the  house  and  its  surroundings  should  be  carefully  inspected.  The 
cellar  or  basement  should  be  clean  and  dry;  if  there  is  a  well,  it 
should  be  so  located  as  to  prevent  the  water  from  being  poisoned  by 
foul  drainage  from  stable  or  outhouses.  Pools  of  stagnant  water, 
manure  heaps,  piles  of  garbage,  refuse  or  rubbish  of  any  sort,  and 
open  privies  furnish  breeding  places  for  disease-carrying  insects, 
such  as  flies  and  mosquitoes. 

THE  NURSERY. 

A  bright,  sunny  room  should  be  chosen  for  the  nursery,  for  a  child 
needs  sunshine  for  health  and  growth  just  as  a  plant  does,  and,  like 
a  plant,  will  droop  and  pine  without  it.  Windows  opening  to  the 
south,  southeast,  or  southwest  will  admit  the  sun  for  many  hours  of 
the  day,  and  a  room  so  lighted  will,  in  the  northern  parts  of  the 
country,  be  most  desirable.  In  the  south,  it  may  be  better  to  select 
a  more  shaded  room,  especially  for  the  summer  months. 

Whenever  possible,  the  room  should  be  given  up  to  the  exclusive 
use  of  the  baby  in  order  that  temperature,  light,  and  ventilation 
may  be  easily  adapted  to  his  special  needs  and  everything  can  be 
so  arranged  as  best  to  serve  his  welfare  and  the  convenience  of 
the  mother.  It  is  very  hard  to  give  the  baby  the  quiet  and  privacy 
he  ought  to  have  in  a  room  that  must  be  occupied  also  by  other 
members  of  the  family. 

Temperature. 

A  very  young  baby,  or  a  delicate  one,  requires  a  warmer  room 
than  one  older  or  more  robust.  For  the  first  few  weeks  the  daytime, 
temperature  should  be  kept  between  65  and  70  degrees.  At  night 
it  may  fall  from  10  to  15  degrees  lower,  if  the  baby  is  properly  dressed 
and  protected.  (See  section  on  night  clothing,  p.  20.)  For  older 
babies  the  day  temperature  may  be  from  65  to  68  degrees,  and  the 
night  from  15  to  30  degrees  lower,  depending  somewhat  on  the  con- 
dition of  the  baby.  A  healthy  child  is  easily  accustomed  to  a  cold 
room  and  is  not  harmed  by  it  if  he  is  kept  thoroughly  warm  in  his 


INFANT   CARE.  13 

crib  and  protected  by  screens  against  drafts  of  cold  air.  If  the 
mother  is  in  doubt  about  the  baby's  welfare  on  a  cold  winter  night 
she  should  test  his  feet  and  hands.  If  they  are  warm,  and  he  is 
sleeping  quietly,  she  may  be  reassured.  If  they  are  cold,  he  needs 
more  body  clothing,  more  covers,  or  to  be  screened  more  completely 
from  cold  air.     (See  section  on  sleeping  bags,  p.  21.) 

Winter. — In  these  months  of  the  year  when  artificial  heat  is  needed 
it  is  possible  to  control  the  temperature  of  the  baby's  room,  to  a 
large  extent.  This  is  done  most  conveniently  with  hot  air,  hot  water, 
or  steam  heating  systems ;  but  even  with  stoves  burning  coal  or  wood 
it  is  possible  by  careful  management  to  regulate  the  heat  of  the  rooms. 
Oil  and  gas  heaters  should  be  used  only  to  secure  quick  temporary 
heat,  as,  for  example,  when  the  bathroom  is  to  be  warmed  for  the 
bath.  Open  fires  are  pleasant,  but  if  used  without  other  heating 
apparatus  are  not  very  well  adapted  to  nursery  purposes,  as  they 
create  more  or  less  draft,  and  do  not  warm  the  room  evenly.  In 
mild  weather  or  for  cool  nights  and  mornings  in  warm  weather  such 
a  fire  is  a  great  comfort.  Needless  to  say,  open  fires  must  be  care- 
fully screened  to  avoid  accidents. 

Summer. — In  summer,  in  most  parts  of  the  United  States,  the 
problem  is  to  keep  the  nursery  cool,  at  least  during  the  day.  In 
the  hottest  weather  the  lower  part  of  the  house  is  usually  cooler  than 
nearer  the  roof,  and  it  may  be  wise  to  move  the  baby  about  in  order 
to  secure  a  place  for  him  to  take  his  daytime  naps  in  comfort. 
Although  the  evening  may  be  very  hot,  the  temperature  usually  falls 
before  morning,  and  in  some  parts  of  the  country  summer  nights 
get  quite  cold.  In  all  these  varying  conditions  the  mother  must  use 
her  common  sense  and  her  ingenuity  to  make  the  baby  as  comfortable 
as  possible.  He  should  wear  only  the  band  and  diaper  during  the 
hot  hours  of  the  day,  and  light  clothing  at  night,  if  the  heat  con- 
tinues; and  his  body  may  be  cooled  with  a  sponge  bath  upon  going 
to  bed. 

The  temperature  of  the  baby's  room  should  be  regulated  by  a  ther- 
mometer, hung  about  3  feet  from  the  floor.  No  active  adult  can 
guess  accurately  the  temperature  prevailing  about  the  baby's  body. 
A  thermometer  is  an  inexpensive  necessity  in  every  well-regulated 
nursery.     (See  section  on  sleep,  p.  27.) 

Ventilation, 

If  doors  and  windows  are  on  opposite  sides  of  the  room,  a  cross 
current  is  set  up  when  they  are  opened  and  the  room  is  quickly  filled 
with  fresh  air.  When  there  is  but  one  window  and  the  door  opens 
onto  a  hall,  a  cross  current  may  be  secured  by  opening  the  doors  and 
windows  of  other  rooms  at  the  same  time.  In  very  cold  weather  it 
is  a  matter  of  great  difficulty  to  keep  the  rooms  warm  enough  for  com- 


14  INFANT  CARE. 

fort  and  yet  well  aired.  As  far  as  the  nursery  is  concerned,  this  must 
be  made  a  regular  part  of  the  mother's  daily  program.  Daytime 
ventilation  should  be  secured  several  times  a  day  by  opening  all  the 
doors  and  windows  wide  for  a  few  minutes  while  the  baby  is  out  of 
the  room,  allowing  the  cold  air  to  flood  every  part  of  the  room,  as 
it  will  very  quickly  do.  The  windows  should  then  be  closed  and  the 
heat  turned  on  to  restore  the  temperature  before  the  baby  is  brought 
back.  In  milder  weather,  the  window  may  be  left  open  a  crack  at 
the  top,  or  more  or  less  constant  ventilation  may  be  secured  through 
the  use  of  various  devices  such  as  window  boards.  A  wooden  or 
glass  board,  10  or  12  inches  high,  resting  on  the  window  sill  and 
slanting  toward  the  inside  of  the  room  is  held  in  place  by  triangular 
supports  at  each  end.  This  turns  the  air  upward  and  prevents  it 
from  cooling  the  lower  part  of  the  room  too  suddenly.  Ideally,  an- 
other window  should  be  open  slightly  at  the  top  to  secure  cross  venti- 
lation. By  another  plan  an  opening  a  few  inches  wide,  either  at  the 
top  or  bottom  of  the  window,  is  closed  with  a  board  cut  to  fit  the 
opening.  This  permits  the  air  to  enter  in  the  space  between  the 
sashes  at  the  middle  of  the  window  and  distributes  it  so  that  it  does 
not  fall  directly  upon  the  heads  of  the  occupants  of  the  room. 

For  ventilating  the  nursery  at  night  in  cold  weather,  especially 
when  the  wind  blows,  cloth  screens  will  be  found  a  great  convenience. 
Tack  one  or  more  thicknesses  of  cheesecloth  on  a  wooden  frame  and 
insert  in  the  open  window,  like  an  ordinary  wire  screen.  The  cloth 
breaks  up  the  air  current  and  distributes  it  in  various  directions,  thus 
preventing  drafts.  A  narrow  cloth  screen  a  few  inches  wide  may  be 
inserted  in  an  opening  at  the  top  of  the  window,  thus  making  it  pos- 
sible to  keep  the  window  open  most  of  the  time,  even  in  very  cold 
weather.  Save  during  extraordinary  weather  conditions,  such  as 
heavy  storms  or  excessively  high  winds,  there  is  little  if  any  time 
when  outside  windows  should  not  be  kept  open  in  the  nursery.  It 
is  quite  possible  to  shield  the  crib  or  bed  in  such  a  way  that  no  direct 
draft  falls  on  the  baby,  and  if  protected  from  exposure  to  chill,  he 
is  far  better  off  with  plenty  of  fresh  outside  air  circulating  through 
the  room  while  he  sleeps  than  in  a  close,  hot  atmosphere.  When  the 
baby  must  occupy  a  room  with  older  persons  it  is  particularly  neces- 
sary to  secure  a  constant  inflow  of  fresh  air.  This  is  true  for  all 
seasons  and  climates.  The  old  superstition  regarding  the  harmful- 
ness  of  night  air  is  entirely  done  away  with.  "  Night  air  "  is  the  only 
air  there  is  to  breathe  at  night,  and,  as  a  matter  of  fact,  it  is  apt  to  be 
purer  than  day  air,  having  been  cleansed  by  dew  or  fog  of  the  dust 
stirred  up  in  the  daytime.  The  use  of  outdoor  sleeping  porches  has 
greatly  assisted  in  solving  the  problem  of  ventilation  for  sleeping 
rooms.  Healthy  babies  can  safely  sleep  outside,  at  least  in  mild 
weather,  if  properly  dressed,  and  if  the  porch  is  screened  and  pro- 


INFANT   CARE.  15 

tected.    Such  a  porch  is  also  a  great  aid  in  the  daytime  care  of  a  baby. 
(See  section  on  outdoor  life,  p.  34;  also  sleeping  bags,  p.  21.) 

Walls  and  floors. 

The  baby's  room  should  be  kept  scrupulously  clean.  If  the  house 
is  old  the  nursery  should  be  freshly  papered  and  painted.  The  walls 
may  be  painted  or  covered  with  waterproof  wall  paper  which  can 
be  wiped  off  with  a  damp  cloth. 

A  bare  floor  may  easily  be  kept  clean.  Hard  woods  are  preferable 
since  they  do  not  splinter,  but  a  soft-wood  floor  painted  or  var- 
nished will  do  very  well.  Linoleum  may  be  used  on  an  old  floor ;  it 
is  easily  cleaned.  Washable  rugs  may  be  used,  if  desired,  but  heavy 
rugs  and  carpets  are  not  suitable  for  a  nursery.  When  the  baby  is 
large  enough  to  sit  on  the  floor  to  play,  a  mat  or  a  heavy  blanket 
folded  or  even  a  clean  comfort  may  be  used  as  a  mat.  This  is  most 
important  in  winter  when  there  are  cold  floor  drafts.  A  play  pen 
with  a  raised  floor  is  a  great  convenience  in  such  circumstances. 

Furnishings. 

Everything  not  actually  needed  for  the  care  of  the  baby  should  be 
ruled  out  of  the  nursery.  Furnishings  must  be  of  such  a  nature  as 
to  permit  washing  with  soap  and  water  and  exposure  to  sunshine 
and  open  windows.  If  old  furniture  is  used,  it  may  be  painted  with 
white  or  light  washable  paints.  Upholstered  furniture,  heavy  dra- 
peries, or  covers  are  unsuitable  for  use  in  this  room.  Following  is  a 
list  of  the  essentials: 

Bed. 

Bed  furnishings. 

Bureau  or  chest  of  drawers  for  clothing.  A  sectional  book- 
case is  admirable  for  this  purpose,  as  the  piles  of  garments 
can  be  seen  at  a  glance.  The  upper  section  may  be  used  to 
hold  the  articles  for  the  bath. 

One  or  two  low  chairs. 

Bathing  equipment. 

Toilet  equipment. 

A  bed  or  couch  for  nurse  or  mother,  if  she  must  sleep  in  the 
same  room. 

A  wall  thermometer. 

A  low  chair  without  arms,  for  the  mother  when  nursing  the 
baby. 

Other  useful  articles  are: 

Dressing  table. 

A  little  chair  and  table  for  use  of  the  child. 

Platform  scales  with  flat  basket. 

Table  to  hold  scales. 

A  folding  canvas  table  on  which  to  bathe,  change,  and  dress 

the  baby. 
A  screen,  covered  with  washable  material. 
A  nursery  ice  box. 
A  bath  thermometer. 


16  INFANT   CARE. 

The  bath  equipment  will  include  a  tub,  either  tin,  enameled  ware, 
or  rubber,  a  washbasin,  an  enameled-ware  tray,  or  a  box  or  drawer 
iivided  into  compartments  in  which  are  kept  such  things  as — 

Absorbent  cotton ; 
Boric-acid  solution, 
Safety  pins  (three  sizes)  ; 
Soap  (Castile) ; 
Squares  of  gauze  or  old  linen ; 
Talcum  powder; 

Tube  of  vaseline,  albolene,  or  cold  cream ; 
Soft  baby  brush  or  comb ; 
and 

Six  soft  linen  towels; 

Six  cheesecloth  or  mosquito  netting  wash  cloths ; 
Bath  apron  (butcher  style) ,  outing  flannel ; 
Bath  towel  for  mother's  lap  or  dressing  table. 

The  toilet  equipment  may  be  kept  in  the  bathroom.  It  should  in- 
clude a  painted  nursery  chair,  with  a  cushion  for  the  seat;  a  small 
chamber  of  enameled  ware  (a  porcelain  cuspidor  is  convenient) ;  a 
covered  enameled-ware  slop  pail  for  diapers  (two  are  desirable) ; 
and  a  soiled-clothes  hamper. 

For  the  baby  in  the  second  year  other  articles  will  be  needed.  He 
should  have  a  high  chair,  for  meals ;  one  or  two  low  chairs ;  a  foot 
rest  for  his  toilet  chair ;  and  a  play  pen.  A  hinged  gate  at  staircases 
is  often  necessary. 

Bed. — The  first  bed  may  be  a  basinette,  or  may  be  made  from  a 
large  flat  clothes  basket,  or  even  from  a  clean  box.  For  this  simple 
form  of  bed  a  folded  quilt  or  blanket  may  be  used  as  a  mattress. 
Since  a  larger  bed  will  soon  be  needed,  it  is  just  as  well  to  start  in 
with  the  permanent  crib  and  a  mattress  of  hair,  felt,  or  cotton.  Home- 
made mattresses,  stuffed  with  cotton,  moss,  or  even  straw  may  be 
used,  with  a  soft  cotton  pad  over  them.  When  a  basket  bed  is  to  be 
used  it  should  stand  on  a  table  or  on  two  chairs  placed  with  their 
seats  together,  and  should  never  be  left  on  the  floor  while  the  baby 
is  in  it.    It  is  well  to  pad  the  ends  and  one  side  of  a  metal  crib. 

The  mattress  should  always  be  protected  by  rubber  sheeting,  oil- 
cloth, or  newspapers,  but  a  soft  pad  of  some  sort  should  be  spread 
directly  under  the  baby. 

There  is  a  combination  bed  and  play  pen  on  the  market  which  is 
very  convenient,  particularly  in  small  rooms,  as  it  may  be  easily 
moved  between  the  house  and  porch  or  from  room  to  room.  It  is 
covered  with  wire  netting  and  furnished  with  a  mattress,  maldng 
it  safe  and  comfortable  for  the  baby  both  for  day  and  night  use,  while 
he  is  young.     (See  section  on  creeping  pen,  p.  35.) 

To  make  the  baby's  bed  when  a  metal  crib  is  in  use,  cover  the 
mattress  or  the  middle  section,  with  the  oilcloth   or   soft   rubber 


INFANT    CARE.  17 

sheeting,  to  each  corner  of  wnich  a  strong  tape  has  been  sewed. 
Tie  these  tapes  together  under  the  mattress  to  hold  the  rubber  smooth. 
(If  desired,  the  rubber  cover  may  be  made  like  a  pillowcase,  cover- 
ing the  mattress  entirely.)  Over  this  place  the  cotton  pad,  then  cover 
with  a  small  sheet,  which  should  be  tucked  under  the  mattress  on 
all  four  sides,  so  that  the  bed  is  perfectly  smooth.  If  sleeping  bags 
are.  used,  no  other  covers  are  needed.  The  bed  may  be  finished 
with  a  neat  dimity  spread,  which  is  easily  washed  and  requires  no 
ironing. 

A  baby  will  breathe  more  easily  and  take  a  larger  supply  of  air 
into  the  lungs  if  no  pillow  is  used.  If  the  mother  desires,  she  may 
place  a  clean,  folded  napkin  under  the  baby's  head,  but  the  head 
should  not  be  elevated  appreciably. 

Dressing  table. — Many  mothers  find  it  convenient  to  have  a  table 
on  which  to  change,  bathe,  and  dress  the  baby.  It  does  away  with 
much  lifting,  lessens  the  strain  on  the  mother,  and  gives  her  freer 
use  of  both  hands.  This  table  may  be  of  whatever  height  the  mother 
finds  most  suitable,  according  to  her  own  stature  and  whether 
she  prefers  to  stand  or  sit  while  making  the  baby's  toilet.  One 
model  is  about  30  inches  from  the  floor.  A  common  kitchen  table 
having  the  legs  sawed  off  to  the  desired  height  will  answer  every  pur- 
pose. Such  tables  are  sometimes  fitted  with  drawers,  sliding  shelves, 
towel  racks,  and  compartments  of  various  kinds,  but  a  much  simpler 
one  will  do  and  will  be  found  a  great  convenience.  If  the  table  top 
is  made  of  white  maple  or  oak  with  very  tight  cracks,  it  can  be 
scrubbed  with  hot  water  and  soap  as  often  as  desired.  If  soft  wood 
or  an  old  table  is  used,  it  will  be  better  to  cover  the  top  with  oilcloth, 
or  even  with  tin.'  Of  course  the  baby  is  always  put  down  on  a  soft 
pad,  whatever  the  material  of  the  table  top. 

THE  CARE  OF  THE  BABY. 
CLOTHING  THE  BABY. 

Dress  the  baby  carefully,  turning  him  as  little  as  possible.  The 
mother  quickly  learns  the  best  and  most  efficient  method.  A  little 
baby  may  be  much  fatigued  by  a  too-prolonged  toilet. 

Clothing  must  be  adapted  to  climate,  season,  and  to  the  age  and 
condition  of  the  baby.  Young  babies  and  those  who  are  weakly  need 
warm  clothing,  as  they  are  easily  chilled.  Robust  babies  quickly 
adapt  themselves  to  the  prevailing  temperature,  and  especially  as 
they  grow  older  and  more  active  are  sometimes  too  warmly  dressed. 

If  the  baby's  hands  and  feet  are  cold  or  he  looks  pinched  and  blue 
about  the  lips,  he  needs  warmer  clothing.  If  he  continually  per- 
spires and  his  body  is  moist  to  the  touch  he  has  too  much  on.  Over- 
dressed babies  are  likely  to  be  restless  and  fretful.  In  hot  weather 
44527°— 21- 2 


18  INFANT  CARE. 

and  in  warm  climates  light-weight  garments  should  be  chosen,  while 
in  the  North  or  in  winter  much  heavier  and  warmer  articles  will  be 
necessary.  Doctors  for  the  most  part  believe  that  shirts,  bands,  and 
stockings  for  the  young  baby  should  have  some  admixture  of  wool. 
If  necessary,  they  may  be  of  the  lightest  weight,  and  in  the  hottest 
weather  only  the  band,  diaper,  and  slip  need  be  worn. 

All  clothing  should  be  simple.  Elaborate  decoration  is  entirely 
unsuitable  to  a  baby's  clothing.  It  may  be  as  fine  and  dainty  as  the 
mother  can  afford,  but  should  admit  of  constant  washing. 

The  dresses  and  skirts  may  be  26  inches  in  length,  the  extra  length 
being  used  to  cover  the  baby's  feet  and  to  add  to  the  convenience  of 
handling  him.  In  hot  climates  the  clothing  may  be  made  short  from 
the  start.    This  is  a  great  economy,  both  of  time  and  expense. 

The  following  list  gives  the  clothing  necessary  for  the  average 
newborn  baby: 

Diapers    dozen—  4  to  8 

Knitted  bands number__  2  to  4 

Knitted    shirts_: do 2  to  4 

Flannel   petticoats do 2  to  4 

Nightgowns do_ 3 

White  cotton  slips do 4  to  8 

Coat  and  caps. 

Long  bootees  or  stockings pairs 2  to  4 

Sacques _ Number__  3 

Wraps  or  blankets do 3 

Diapers. 

Cotton  bird's-eye  is  the  usual  material  for  diapers.  They  should 
be  twice  as  long  as  they  are  wide,  and  at  least  two  sizes  will  be  neces- 
sary. One  set  may  be  18  by  36,  or  22  by  44  inches,  and  the  large  ones 
26  by  52  inches.  The  cloth  should  be  washed  and  shrunk  before  it  is 
hemmed  or  at  least  1  inch  should  be  allowed  on  each  diaper  for  shrink- 
ing. For  the  first  diapers  nothing  is  better  than  a  fine  grade  of  cheese- 
cloth; they  should  be  one  yard  wide,  so  that  when  folded  twice  the 
diaper  shall  have  four  thicknesses  one-half  yard  square.  Cheese- 
cloth washes  very  easily  and  is  both  soft  and  absorbent.  Many 
mothers  prefer  using  old  pieces  of  household  cotton  for  the  first 
diapers,  and  also  for  inside  pads  to  catch  the  heavier  discharges.  Care 
should  be  taken  not  to  use  diapers  which  are  too  bulky,  as  they  may 
cause  th^gh  deformities.  The  number  of  diapers  to  be  provided  de- 
pends upon  the  washing  facilities.  It  is  much  easier  to  have  a  large 
dumber  of  diapers  than  to  be  obliged  to  wash  them  every  day ;  5  or  6 
dozen  is  not  too  many  for  convenience,  but  two  dozen  of  each  size 
will  keep  the  baby  fairly  well  supplied. 

Care  of  the  diapers. — No  diapers  should  be  used  a  second  time  be- 
fore being  washed.   Used  diapers  should  never  be  left  lying  about  the 


INFANT   CARE.  19 

room  nor  hung  up  to  dry  on  the  radiators.  Wet  diapers  should  be 
placed  at  once  in  a  covered  pail  and  left  to  soak  in  cold  water  until 
they  can  be  washed.  If  soiled  diapers  can  not  be  attended  to  at  once 
they  should  be  placed  in  a  separate  covered  pail,  and  if  they  are  to  be 
washed  within  24  hours  it  will  be  better  not  to  soak  them,  as  in  that 
way  the  stains  spread  throughout  the  entire  diaper.  All  solid  dis- 
charges should  be  removed  from  the  diaper  and  it  should  not  be  put 
into  the  tub  until  nothing  but  the  stain  is  left.  This  is  done  by  hold- 
ing the  soiled  diaper  over  the  closet  and  removing  all  the  solid  stool 
by  shaking,  brushing,  or  scraping.  It  is  well  to  keep  a  case  knife  in 
some  convenient  place  solely  for  this  purpose.  If  a  brush  is  used  it 
must  be  thoroughly  washed  at  the  end  of  the  operation.  The  soiled 
diapers  must  be  rinsed  through  several  waters,  using  the  pail  in  which 
they  have  been  stored.  They  may  then  be  washed  with  the  wet  diapers. 
All  the  diapers  should  be  washed  in  very  hot  water  with  plenty  of 
mild  white  soap.  No  washing  powder  of  any  sort  is  permissible. 
They  should  be  well  boiled  and  rinsed  through  several  waters.  Much 
of  the  irritation  of  the  thighs  and  buttocks,  which  is  the  source  of 
such  severe  suffering  to  babies,  is  caused  by  insufficient  rinsing  of  the 
diapers.  Whenever  possible  diapers  should  be  dried  in  the  sunshine 
and  open  air.  They  may  be  used  without  ironing,  but  they  are  softer 
and  look  better  ironed.  An  inner  pad  may  be  used  to  protect  the 
diaper  from  the  worst  of  the  soiling  and  thus  decrease  the  labor  of 
washing.  During  the  day  the  diaper  should  be  changed  as  often  as  it 
is  wet  or  soiled.  In  the  night  it  should  be  changed  when  the  baby  is 
taken  up  to  be  fed.  Diapers  should  be  put  on  so  that  the  principal 
thickness  is  not  between  the  legs.  (See  training  the  bowels  and  blad- 
der, pp.  42,  43.) 

Waterproof  diapers. — There  are  on  the  market  certain  waterproof 
diapers  which  can  be  washed  with  boiling  water  which  may  be  used 
for  very  short  periods.  It  is  a  great  comfort  to  the  mother  to  be  able 
to  feel  that  baby  will  not  wet  through  his  clothing  while  she  is  taking 
him  on  a  short  journey.  Needless  to  say,  however,  waterproof  diapers 
are  suitable  only  for  temporary  use  and  the  baby  should  be  changed 
just  as  often  as  when  such  diapers  are  not  a  part  of  his  toilet.  If  he 
is  allowed  to  go  for  any  length  of  time  in  a  wet  diaper,  the  skin  is 
certain  to  become  sore.  Waterproof  diapers  are  especially  dangerous 
to  girl  babies. 

Bands. 

Abdominal  bands,  used  to  hold  the  navel  dressing  in  place,  are 
unhemmed  strips  of  part-wool  flannel  6  to  8  inches  wide  and  18  to 
20  inches  long.  The  navel  dressing  may  be  held  with  surgical  gauze 
bandages,  making  flannel  binders  unnecessary.  In  this  case,  the 
knitted  band  with  shoulder  straps  will  be  used  from  the  start. 


20  INFANT  CAKE. 

Whatever  sort  of  band  is  used  it  should  never  "  bind."  A  band,  if 
drawn  tightly  about  the  abdomen,-  does  not  prevent  rupture  and  may 
do  harm  if  the  pressure  is  in  the  wrong  place.  The  abdominal 
muscles  of  a  healthy  baby  need  little  support,  save,  perhaps,  in  the 
earliest  weeks  of  life;  rather  they  need  free  play  in  order  to  be 
strengthened  in  the  natural  way  by  the  slight  exercise  the  baby  can 
give  them.  The  knitted  band  with  shoulder  straps  should  be  substi- 
tuted for  the  flannel  band  if  this  is  used  as  soon  as  the  navel  has 
healed.  The  band  should  be  fastened  with  tiny  safety  pins  or  with 
tapes  just  at  one  side  of  the  front,  never  in  the  back. 

Shirts. 

Knitted  bands  and  shirts  come  in  several  weights  and  sizes.  It  is 
well  to  begin  with  the  second  size,  as  the  first  is  soon  outgrown.  They 
are  all  wool,  or  wool  and  silk,  wool  and  cotton,  all  silk,  or  all  cotton. 
Usually  either  the  cotton-and-wool  or  silk-and-wool  mixtures  are  best. 
For  hot  weather  the  lightest  weight  should  be  selected  for  the  average 
healthy  baby.  The  shirts  should  open  all  the  way  down  the  front,  and 
they  must  be  large  enough  so  that  the  sleeves  will  easily  slip  on  and 
off.  Occasionally  a  baby  may  be  found  whose  skin  is  so  delicate  that 
it  is  irritated  by  even  the  smallest  amount  of  wool.  For  such  babies 
the  all-silk  or  the  all-cotton  garments  may  be  selected.  In  the  North 
or  in  winter,  or  for  very  young  or  weak  babies,  the  shirts  and  bands 
should  be  at  least  half  wool.  All  young  babies  should  have  at  least 
one  garment  that  is  part  wool. 

Petticoats. 

Part-wool  flannel  should  be  used  for  the  petticoats,  selecting  the 
lightest  weight  for  hot  weather.  Even  for  the  newborn  baby  the 
petticoat  should  not  extend  more  than  10  inches  below  the  feet,  and 
if  the  weather  is  hot,  it  may  be  several  inches  shorter.  In  hot  cli- 
mates all  the  clothing  may  be  short  from  the  start.  Skirts  may  be 
made  by  the  Gertrude  or  princess  pattern,  closing  on  the  shoulders. 
Muslin  petticoats  are  unnecessary  for  the  young  baby. 

Slips. 

Slips  are  very  simply  made  of  fine  white  cotton  materials,  such  as 
nainsook,  long  cloth,  or  batiste.  They  should  not  be  over  28  inches 
long  and  may  be  shorter.  If  made  in  kimono  style,  they  may  have  a 
tuck  over  each  shoulder  which  will  permit  them  to  be  easily  enlarged. 
Drawstrings  in  the  neck  and  sleeves  will  also  make  it  possible  to 
adapt  the  garment  to  the  baby  as  he  grows  larger.  No  trimming 
which  can  scratch  or  irritate  the  tender  skin  of  the  baby's  neck  is 
permitted,  and  his  garments  should  not  be  starched. 

Night  clothing. 

A  simple  wrapper  which  opens  all  the  way  down  the  front  is  a 
useful  garment,  particularly  for  a  very  young  baby  and,  if  desired, 


INFANT    CARE.  21 

may  take  the  place  of  the  slip  during  the  first  few  weeks.  Any 
soft  material  may  be  used,  but  part-wool  or  cotton  flannel  is  com- 
monly chosen.  It  must  be  remembered  that  the  fuzzy  surface  of 
all  cotton  flannels  is  highly  inflammable,  and  care  must  be  taken 
to  guard  against  fire  when  this  material  is  used  in  children's  clothing. 
These  wrappers  may  be  worn  as  nightgowns  when  the  baby  is  older. 
Nightgowns,  both  long  and  short,  may  be  bought  ready-made,  a  very 
satisfactory  sort  being  made  of  single  stockinet. 

Winter  nightgowns  for  a  very  young  baby  may  be  drawn  up  at 
the  feet  with  a  string  run  through  the  hem,  but  for  an  older  baby  this 
arrangement  restricts  his  freedom  to  kick.  For  this  reason  night 
garments  made  with  feet  are  better  in  winter  for  older  babies. 

Sleeping  bags. — After  the  baby  is  5  or  6  months  old,  or  whenever 
he  can  not  be  depended  upon  to  remain  wrapped  up  in  his  blankets 
all  night,  he  should  have  a  sleeping  bag.  For  the  winter  the  bags 
may  be  made  of  any  woolen  material,  preferably  a  soft  blanket.  Use 
a  single  blanket,  folding  it  in  the  middle,  crosswise.  Sew  it  to- 
gether on  one  end  and  the  other  side  and  fasten  the  top  in  two  places, 
a  few  inches  apart,  with  hooks  and  eyes.  Put  the  baby  inside  the 
bag  and  fasten  over  each  shoulder.  In  the  coldest  weather  two  or 
three  bags  may  be  used  if  necessary.  In  summer  the  bag  is  made 
of  muslin  or  outing  flannel.  A  small,  thin  sheet  will  do  for  the 
hottest  weather,  and  little  or  no  clothing  need  be  worn  under  such  a 
bag.  A  simpler  plan  for  making  a  bag  for  a  young  baby  is  to  cut 
a  slit  in  the  middle  of  an  old  blanket,  wide  enough  to  permit  it  to 
slip  easily  over  the  baby's  head.  The  cut  edges  are  bound  or 
stitched.  The  blanket  is  slipped  over  the  baby's  head,  smoothed 
down  under  and  over  him,  and  the  lower  corners  folded  toward  the 
middle  and  fastened  with  safety  pins.  This  makes  it  possible  to 
change  the  baby  without  taking  him  out  of  the  blanket. 

A  mother  who  has  tried  sleeping  bags  will  never  be  persuaded  to 
return  to  the  ordinary  bed  covers.  By  means  of  the  bag  the  baby 
can  never  uncover  himself,  and  thus  will  be  saved  many  a  chill ;  and, 
in  addition,  the  mother  can  sleep  undisturbed  by  the  necessity  of  get- 
ting up  to  cover  the  baby  during  the  night. 

In  addition  to  the  bag,  a  nightcap  will  be  needed  in  cold  weather, 
especially  if  the  baby  sleeps  out  of  doors.  A  wool  stocking  cap  or  a 
flannel  hood,  lined  with  cotton  or  silk  and  tied  under  the  chin,  may  be 
used.  A  little  cape  sewed  to  the  bottom  of  the  cap  will  help  to  pro- 
tect the  neck  in  cold  weather.  This  cape  may  be  fastened  to  the 
sleeping  bag  at  the  back. 

Shoes  and  stockings. 

It  is  important  to  keep  the  legs  and  feet  of  a  young  baby  very 
warm.  While  he  is  in  long  clothes  they  may  need  no  other  cov- 
ering,  but   in    cold   weather    and    in    changeable    climates    it    will 


22  INFANT  CAKE. 

probably  be  necessary  to  use  some  sort  of  foot  covering  in  addition 
to  the  skirts  and  blankets  with  which  he  is  wrapped.  The  mother 
should  feel  of  the  baby's  feet  often,  as,  for  instance,  when  she  is  chang- 
ing the  diaper,  and  if  they  are  cold  they  should  be  dressed.  The 
older  baby  can  go  barefooted  much  of  the  time  in  warm  weather  but 
should  not  be  allowed  to  go  any  length  of  time  with  cold  feet,  and 
he  will  need  shoes  and  stockings  as  soon  as  he  begins  to  walk,  to 
protect  the  feet  from  injury. 

The  best  stockings  are  part  wool.  Those  described  as  "  unshrink- 
able," said  to  be  made  of  a  mixture  of  wool  and  linen,  are  somewhat 
expensive  but  are  genuine  economy,  as  they  are  very  durable  and 
will  last  until  fully  outgrown.  Others  are  of  wool  and  cotton,  or 
wool  and  silk.  Three  pairs  will  answer,  beginning  with  the  second 
size.  They  may  be  quickly  washed  out  and  dried  on  stocking 
stretchers.  A  loop  of  tape  may  be  sewed  to  the  top  of  the  stocking, 
through  which  to  slip  the  safety  pin  which  holds  them  to  the  diaper. 

Knitted  bootees,  the  conventional  gift  to  the  baby  and  dear  to  the 
young  mother's  heart,  should  be  long  and  have  a  turn  at  the  knee. 
Like  other  all-wool  garments  they  shrink  and  harden  very  easily 
unless  carefully  washed.  When  taking  the  baby  out  in  cold  weather, 
or  for  outdoor  sleeping,  short  bootees  may  be  worn  over  stockings, 
like  shoes.  Care  should  be  taken  not  to  tie  the  strings  tight  about 
the  ankles. 

For  the  older  baby  soft  shoes  or  moccasins  may  be  made  at  home 
from  old  kid  gloves,  or  from  flannel  or  felt.  High  woolen  boots, 
to  pull  on  over  the  baby's  shoes  and  stockings  for  extra  warmth,  may 
also  be  made  from  flannel  or  eiderdown. 

When  the  baby  begins  to  walk  he  will  need  shoes  with  firm  soles. 
It  is  no  uncommon  sight  to  see  a  baby  walking  along  an  icy  or  damp 
sidewalk  with  shoes  so  thin-soled  that  it  is  hardly  possible  that  his 
feet  will  not  be  chilled.  Frequently  all  the  rest  of  the  body  is  covered 
with  thick  clothing,  coat,  cap,  and  mittens,  while  the  feet  and  legs 
have  no  additional  covering.  Both  leggings  and  overshoes  are  neces- 
sary in  cold  weather  for  the  baby  who  is  old  enough  to  walk  outdoors. 
(See  section  on  care  of  the  feet,  p.  32.) 

Cloaks  and  caps. 

Since  a  baby  exercises  very  little  when  taken  out  in  a  carriage,  he 
must  be  warmly  wrapped  if  the  day  is  cold.  Cloaks  should  either 
be  of  warm  woolen  material  or  have  an  interlining  of  wool,  or,  in 
cold  climates,  both.  For  the  "runabout"  baby  additional  warmth 
is  secured  by  the  use  of  leggings,  a  sweater,  overshoes,  and  mittens. 
Summer  wraps  may  be  made  of  silk  or  cotton,  although  a  cloak  of 
challis,  cashmere,  or  nun's  veiling  has  more  warmth  and  at  the  same 
time  is  light  in  weight.     Caps  should  not  be  thick  enough  to  cause 


INFANT   CAKE.  23 

the  head  to  perspire.  A  silk  cap  with  an  interlining  of  wool  wad- 
ding or  of  flannel  may  be  used  in  winter.  Hoods  or  caps  knitted 
of  woolen  yarn,  having  a  cape  to  come  down  under  the  coat  collar 
and  protect  the  neck,  are  excellent  in  the  coldest  weather,  but  are 
too  warm  in  mild  climates.  Silk  or  muslin  caps  may  be  worn  in  the 
milder  months,  or  the  baby  may  go  bareheaded  if  protected  from  the 
sun.  No  starch  should  be  used  in  the  caps,  as  stiff  strings  or  ruffles 
scratch  the  delicate  skin  and  may  lead  to  eczema.  Cap  strings  and 
ribbons  should  be  carefully  examined  after  the  child  is  dressed,  to 
see  that  they  are  not  too  tightly  tied. 

The  older  baby  may  be  dressed  for  cold  weather  in  a  knitted 
woolen  garment  which  covers  him  from  neck  to  toes. 

Additional  clothing  for  the  older  baby. 

The  baby  may  go  into  short  clothes  as  early  as  the  mother  pleases. 
Indeed  his  clothing  may  have  been  short  from  the  start,  as  has 
already  been  said.  In  most  cases,  the  first  clothing  can  be  shortened 
as  needed,  and  if  the  slips  and  petticoats  have  been  made  large 
enough  in  the  beginning  they  may  be  used  for  a  year  or  more.  The 
baby  will  outgrow  his  first  shirts,  bands,  and  stockings  and  will  need 
larger  ones  after  a  few  months. 

During  the  second  year  if  the  baby  has  been  trained  to  the  use 
of  the  chamber  he  will  go  into  drawers  and  will  then  need  under- 
waists  and  long  garters.    Round  garters  should  never  be  used. 

After  a  child  begins  to  try  to  walk  his  skirts  are  very  much  in 
his  way,  and  some  kind  of  rompers  is  highly  necessary.  A  sim- 
ple dress,  made  on  the  plan  of  the  envelope  chemise,  is  described  in 
the  third  bulletin  of  this  series.1  Additional  information  regarding 
the  clothing  of  the  older  child  is  given  in  the  same  bulletin.  It  will 
be  sent  free  of  charge  upon  request. 

BATHS  AND  BATHING. 

A  healthy  baby  should  be  bathed  every  day.  During  the  first  two 
weeks  these  and  all  matters  pertaining  to  the  care  of  the  baby  are 
usually  under  the  supervision  of  the  doctor  or  nurse.  When  the 
mother  takes  charge  she  will  find  it  convenient  to  give  the  bath  before 
the  midmorning  feeding  and  after  the  bowels  have  moved.  Direc- 
tions for  the  first  bath  are  given  in  the  pamphlet  on  Prenatal  Care.2 

Sometimes  it  may  be  more  convenient  for  the  mother  to  give  the 
bath  at  night,  just  before  the  baby's  bedtime.  The  full  tub  bath  may 
be  given  as  soon  as  the  scar  where  the  navel  cord  was  attached  has 

1See  West,  Mrs.  Max:  Child  Care,  pt.  1,  The  Preschool  Age,  p.  31.  U.  S.  Children's 
Bureau  Publication  No.  30,  Care  of  Children  Series  No.  3.     Washington,  1918. 

2  See  West,  Mrs.  Max :  Prenatal  Care,  p.  30.  U.  S.  Children's  Bureau  Publication 
No.  4,  Care  of  Children  Series,  No.  1.     Washington,  1921. 


24  INFANT  CARE. 

fully  healed.  For  some  weeks  a  tiny  baby  may  be  bathed  in  a  basin 
or  bowl ;  after  that  he  should  have  an  ordinary  baby  tub.  The  basin 
or  tub  should  always  be  warmed  before  it  is  filled.  The  water  should 
be  at  body  heat  or  slightly  above;  that  is,  from  98°  to  100°.  A 
bath  thermometer  is  an  inexpensive  convenience  and  should  be  pro- 
vided, but  if  none  can  be  had  the  mother  may  test  the  temperature 
with  her  elbow.  When  the  water  feels  neither  hot  nor  cold  it  will  be 
comfortable  for  the  baby.  It  should  be  tested  after  the  baby  is 
undressed  and  ready  to  get  into  the  water.  Hot  water  should  never 
be  added  to  the  bath  while  the  baby  is  in  the  tub.  Never  put  the 
baby  in  the  bath  while  the  tub  is  standing  on  a  stove  or  heater;  he 
might  be  seriously  burned  in  this  way.  Never  leave  a  young  baby 
alone  in  the  tub.  Never  bathe  a  baby  within  an  hour  after  feeding. 
No  unnecessary  exposure  or  delay  should  take  place,  for  in  cold 
or  cool  weather  the  baby  is  quickly  chilled.  He  should  be  protected 
from  drafts  by  screens  or  by  a  shield  made  by  hanging  a  blanket 
over  the  backs  of  two  chairs,  and  all  the  necessaries — such  as  soap, 
wash  cloths  and  towels,  clothing,  bath  apron  for  the  mother,  tub, 
water,  thermometer,  and  powder — should  be  at  hand  before  un- 
dressing the  baby.  A  baby  should  always  have  his  own  towels  and 
wash  cloths  of  soft  cheesecloth  or  old  linen;  the  towels  should 
be  old  and  soft.  Use  a  pure,  bland,  white,  nontransparent 
soap.  Very  little  soap  is  needed,  and  it  is  most  important  that  the 
skin  be  thoroughly  rinsed  after  a  soapy  bath. 

Giving  thei  bath. 

Before  beginning,  the  mother  should  wash  her  own  hands  clean 
and  see  that  there  are  no  pins  or  needles  in  her  clothing  to  scratch 
the  baby.  The  room  should  be  comfortably  warmed — to  about 
75° — for  a  young  baby.  It  is  not  wise  to  have  it  so  hot  that 
the  baby  perspires,  as  there  is  then  grave  danger  of  his  being  chilled 
when  taken  into  another  room  where  the  temperature  is  lower  or 
when  the  room  itself  is  rapidly  cooled.  It  is  often  difficult  to  warm 
the  house  quickly  on  cold  winter  mornings,  especially  in  severe 
winter  weather  or  when  a  cold  wind  is  blowing;  and  sometimes  the 
temperature  does  not  rise  to  a  comfortable  degree  throughout  the 
greater  part  of  the  day.  In  such  cases  the  baby  should  not  be  allowed 
upon  the  floor  at  all  and  should  be  dressed  as  for  out  of  doors,  even 
to  mittens.  Babies  sometimes  suffer  with  cold  hands  indoors  quite 
as  severely  as  with  cold  feet  and  need  to  have  the  hands  well  covered 
both  while  awake  and  asleep.  On  cold  winter  mornings,  the  baby 
should  be  thus  warmly  dressed  and  kept  in  his  crib,  which  may  be 
moved  in  front  of  a  sunny  window  and  heated  with  hot-water  bags  or 
hot  bricks,  until  some  room — nursery,  bath,  or  kitchen — is  warm 
enough  to  permit  his  being  bathed  and  dressed. 


INFANT    CARE.  25 

Before  the  baby  is  completely  undressed  his  face  and  scalp  should 
be  washed.  Wash  the  face  with  a  small  soft  cloth  kept  for  this 
purpose,  then  lay  the  baby  on  his  back  in  the  mother's  lap.  It  is 
usually  more  convenient  to  have  his  head  to  the  right,  and  slightly 
lowered.  Rub  a  little  soap  on  the  cloth  and  wring  it  out  of  the  warm 
water,  so  as  to  make  a  suds.  Lather  the  baby's  head  completely  and 
quickly  and  rinse  several  times  in  clear  warm  water,  all  without 
raising  the  head.  Rub  lightly  and  dry  quickly.  By  this  process  the 
head  is  easily  washed,  without  running  any  risk  of  getting  a  drop  of 
soap  into  the  sensitive  eyes.  The  baby  is  then  turned  about  so  that 
the  mother  may  more  conveniently  use  her  right  hand  for  the  rest  of 
the  bath.  Next,  remove  the  remainder  of  the  clothing  and  go  over 
the  entire  body  with  the  soapy  wash  cloth ;  then  place  the  baby  in 
the  bath,  holding  him  with  the  left  forearm  under  the  neck  and 
shoulders,  the  hand  under  his  arm,  lifting  the  feet  and  legs  with 
the  right  hand.  Use  the  right  hand  to  sponge  the  entire  body,  then 
lift  him  out  and  wrap  him  at  once  in  a  warmed  towel.  Dry  carefully 
with  soft  warm  towels,  patting  the  skin  gently.  Never  rub  the  baby's 
tender  skin  with  anything  less  smooth  than  the  palm  of  the  hand. 
Dress  him  as  rapidly  as  possible  if  the  weather  is  cold,  taking  great 
pains  not  to  expose  him  unnecessarily.  When  the  weather  is  very 
hot  in  summer  only  a  slip  and  diaper  are  needed. 

If  the  skin  is  carefully  dried  after  the  bath  there  will  be  little  need 
for  powder,  and  it  should  never  be  used  as  a  cover  for  careless  drying. 
It  is  well  to  use  a  little  pure  talcum  powder  in  the  creases  and  folds 
of  the  skin,  under  the  arms,  and  around  the  buttocks,  but  it  should 
not  be  used  so  generally  as  to  fill  the  pores  of  the  skin  and  clog  them 
and  should  be  applied  only  after  the  skin  is  dry. 

For  one  reason  or  another  a  baby  sometimes  objects  to  his  bath. 
In  such  cases  judicious  coaxing  may  be  employed.  Toys  which  float 
will  often  divert  the  baby's  attention  and  make  him  forget  his 
objections  to  the  water.  Sometimes  lowering  him  into  the  water 
wrapped  in  a  towel  or  covering  the  top  of  the  tub  with  a  cloth,  so 
that  he  can  not  see  the  water,  will  accomplish  the  result.  If  his 
dislike  has  been  caused  by  having  been  put  at  some  previous  time 
into  a  bath  which  was  too  hot  or  too  cool,  let  him  dabble  in  the  water 
first  with  his  hands  and  feet  until  he  is  reassured.  Sometimes  the 
baby  will  cease  his  objections  to  the  bath  if  his  face  is  not  washed 
until  after  the  tub  bath  is  over.  The  baby  should  be  induced  to  the 
desired  action  by  pleasant  means  which  do  not  upset  his  sensitive 
nervous  system.  Force  or  harshness  is  worse  than  useless  in  this  as 
well  as  in  other  matters  in  the  training  of  the  baby. 

Cool  oath. — The  temperature  of  the  bath  may  be  gradually  low- 
ered until  it  is  down  to  96  degrees  for  a  baby  of  6  months  and  90  or 


26  1XFAXT    CARE. 

even  80  degrees  for  one  of  1  year  of  age.  Toward  the  end  of  the  sec- 
ond year  a  robust  baby  may  be  given  a  cool  sponge,  but  he  should 
never  be  frightened  or  chilled  in  administering  this  wholesome  treat- 
ment. He  should  be  gradually  accustomed  to  it  by  being  allowed  to 
stand  in  his  tub  at  the  end  of  his  daily  bath  with  his  feet  in  the  warm 
water,  while  a  sponge  of  cooler  water  is  squeezed  over  the  throat  and 
chest.  The  water  may  be  made  colder  by  degrees  until  he  is  taking 
it  quite  cool  and  enjoying  it.  He  must  be  rubbed  quickly  and  thor- 
oughly at  once  unfil  the  skin  is  red  and  glowing.  If  this  reaction 
does  not  come  or  if  the  child  shows  any  appearance  of  chill  or  has 
cold  hands  and  feet  two  or  three  hours  after  the  bath  the  treatment 
must  not  be  repeated.  Provided  the  glow  always  comes,  a  quick,  cool 
sponge  douche  or  shower  at  the  end  of  the  bath  is  one  of  the  best 
tonics  that  can  be  found  and  induces  an  excellent  habit  for  after 
life.  After  a  cool  bath  the  child  should  always  have  vigorous  exer- 
cise for  a  few  minutes  in  order  to  promote  the  necessary  reaction. 

Salt  hath. — Use  half  a  teacupful  of  common  or  sea  salt  to  each  gal- 
lon of  water.  The  salt  should  be  dissolved  in  a  cup  of  warm  water 
to  prevent  the  sharp  particles  from  pricking  the  skin.  The  doctor 
sometimes  orders  a  salt  bath. 

/Starch  bath. — Add  a  cupful  of  ordinary  cooked  laundry  starch  to 
a  gallon  of  water. 

Soda  bath. — A  soda  bath  requires  two  tablespoonfuls  of  baking 
soda  to  a  gallon  of  water,  dissolving  it  in  a  little  water  before  adding 
it  to  the  bath. 

Bran  bath. — Make  a  cotton  bag  of  cheesecloth  or  other  thin  mate- 
rial, 6  inches  square.  Fill  loosely  with  bran.  Soak  the  bag  in  the 
bath  water,  squeezing  it  frequently  until  the  water  becomes  milky. 
Starch,  soda,  and  bran  baths  are  often  used  in  place  of  the  soap-and- 
water  bath  when  the  skin  is  inflamed,  as  in  chafing  or  prickly  heat. 

Sea  bathing. 

Although  a  baby  under  2  years  should  not  be  given  a  sea  bath, 
a  word  of  caution  about  sea  bathing  for  young  children  may  not  be 
amiss.  The  cruelty  with  which  well-meaning  parents  treat  young, 
tender  children  by  forcibly  dragging  them  into  the  surf,  a  practice 
which  may  be  seen  at  any  seaside  resort  in  the  summer,  can  have  no 
justification.  The  fright  and  shock  that  a  sensitive  child  is  thus  sub- 
jected to  is  more  than  sufficient  to  undo  any  conceivable  good  result- 
ing from  the  plunge.  On  the  other  hand,  a  child  who  is  allowed  to 
play  on  the  warm  sand  and  becomes  accustomed  to  the  water  slowly 
and  naturally  will  soon  learn  to  take  delight  in  the  buffeting  of  the 
smaller  waves,  but  he  should  not  be  permitted  to  remain  more  than 
a  minute  or  two  in  the  water,  and  should  be  thoroughly  dried,  dressed 
immediately,  and  not  left  to  run  about  the  beach  in  wet  clothing. 


INFANT    CARE.  27 

CARE  OF  SPECIAL  ORGANS. 
Eyes. 

Whether  the  young  bab^  is  awake  or  asleep,  his  eyes  should  always 
be  shielded  from  strong  light,  either  sunlight  or  artificial,  and  from 
dust  and  wind.  Care  should  be  taken  not  to  allow  any  soapy  water 
to  enter  the  baby's  eyes  in  bathing.  Swelling  or  redness  or  any  dis- 
charge should  have  medical  attention  at  once.3 

Mouth. 

A  healthy  baby's  mouth  needs  no  cleaning  before  the  teeth  come. 
The  saliva  js  a  cleansing  fluid,  intended  to  keep  the  mouth  healthy. 
It  is  possible  to  injure  the  delicate  membrane  of  it  by  attempting  to 
clean  with  a  cloth. 

Ears. 

Wash  the  external  ear  with  a  soft  cloth,  but  never  attempt  to  in- 
troduce any  hard  instrument  inside  the  ear  to  clean  it.  Always  dry 
the  ears  and  the  creases  back  of  them  very  carefully. 

Nose. 

The  baby's  nose  should  be  cleaned  as  a  part  of  the  daily  toilet  in 
the  same  way  as  the  ears.  When  the  baby  has  an  infectious  cold  he 
should  have  special  attention.     (See  section  on  colds,  p.  88.) 

Genital  organs. 

These  organs  in  both  sexes  should  be  kept  scrupulously  clean,  with 
as  little  handling  as  possible.  Boys  should  be  examined  by  a  physi- 
cian to  see  whether  or  not  circumcision  is  needed.  The  foreskin 
should  frequently  be  drawn  back  at  bathing  time  until  the  raised 
edge  of  the  glans  is  visible  and  the  organ  cleansed.  If  the  mother 
finds  it  difficult  to  retract  it,  she  should  not  attempt  to  do  this  alone, 
but  should  ask  the  doctor  to  show  her  how.  Perfect  cleanliness  is 
the  principal  treatment  required  in  girl  babies.  Any  swelling  or 
redness  of  the  parts  or  a  discharge,  however  slight,  should  be  brought 
at  once  to  the  doctor's  attention. 

SLEEP. 
Amount. 

A  very  young  baby  should  sleep  from  18  to  22  hours  out  of  24; 
during  the  second  and  third  months  from  18  to  20  hours.  When  he 
is  6  months  old  he  should  sleep  12  hours  at  night  without  interrup- 
tion, save  possibly  for  one  evening  feeding.  At  this  age  he  will 
probably  sleep  2  hours,  both  morning  and  afternoon,  but  should  not 
sleep  after  3  o'clock,  in  order  that  he  may  be  ready  to  go  to  bed  at 
6  o'clock  in  the  evening.  The  long  period  of  night  sleeping  should 
be  continued  throughout  childhood,  but  the  daytime  naps  may  be 


3  See  Prenatal  Care,  p.  30,  for  care  of  newborn  baby's  eyes. 


28  INFANT'   CAKE. 

gradually  shortened.  At  1  year  of  age  the  baby  may  require  one  long 
and  one  short  nap  during  the  day.  •  In  the  second  year  the  two  naps 
are  merged  into  one,  which  may  continue  •from  one  to  two  hours  in 
the  middle  of  the  day.  Even  if  the  child  does  not  sleep  all  this  time, 
the  habit  of  resting  in  a  quiet  room  is  of  great  value.  He  should 
be  provided  with  the  best  possible  sleeping  accommodations,  so  that 
the  hours  of  sleep  may  be  of  the  greatest  value.  He  should  always 
sleep  in  a  bed  by  himself,  and  whenever  possible  in  a  room  by  him- 
self, where  he  need  not  be  disturbed  by  the  presence  of  other  persons, 
and  where  light,  warmth,  and  ventilation  may  be  adjusted  to  his 
particular  needs.  Not  a  few  young  babies  have  been  smothered  while 
lying  in  bed  with  an  older  person,  some  part  of  whose  body  was 
thrown  over  the  baby's  face  during  heavy  sleep. 

Never  give  a  baby  any  sort  of  medicine  to  induce  sleep.  All  sooth- 
ing sirups  or  other  similar  preparations  contain  drugs  that  are  bad 
for  the  baby,  and  many  of  them  are  exceedingly  dangerous.  Many 
babies  die  every  year  from  being  given  such  medicines.  The  baby 
should  never  be  allowed  to  go  to  sleep  with  anything  in  the  nature  of  a 
pacifier  in  his  mouth.  Thumb-  and  finger-sucking  babies  will  rebel 
fiercely  at  being  deprived  of  this  comfort  when  they  are  going  to 
sleep,  but  this  must  be  done  if  the  habit  is  to  be  broken  up.  The 
baby  ought  to  have  a  reasonably  quiet  place  in  which  to  sleep,  but  he 
should  be  taught  to  sleep  through  the  ordinary  household .  noises, 
unless  they  are  unduly  disturbing.  It  should  not  be  necessary  to  walk 
on  tiptoe  and  talk  in  whispers  while  the  baby  sleeps,  provided  4ie  has 
a  quiet  place  for  his  daytime  naps. 

A  baby  should  never  be  put  down  to  sleep  in  all  his  clothes.  His 
shoes,  especially,  should  be  removed,  and,  unless  the  weather  is  very 
cold,  it  is  better  to  remove  the  stockings  also.  But  his  feet  must 
always  be  kept  warm. 

Additional  precautions. 

In  winter. — To  keep  a  baby  warm  all  night  in  excessively  cold 
weather  and  have  sufficient  ventilation  at  the  same  time  is  somewhat 
difficult.  To  accomplish  this,  the  baby  should  be  dressed  in  shirt, 
diaper,  and  stockings  under  his  nightgown  and,  if  necessary,  a  soft, 
roomy  sweater  may  be  used  also.  The  sleeves  of  the  gown  or  sweater 
should  come  down  over  the  hands,  or  mittens  may  be  worn. 

It  may  be  well  to  warm  the  bed  with  hot-water  bottles  or  hot  bags 
of  sand  or  salt.  The  heated  bags  may  be  put  in  at  the  foot  of  the 
bed,  to  keep  the  baby's  feet  warm.  Hot-water  bottles  should  be 
very  carefully  stoppered  and  wrapped  to  prevent  accidents.  The 
baby's  flesh  is  exceedingly  delicate  and  easily  burned,  and  he  can  not 
tell  of  his  discomfort.  Guaranteed  self -regulating  electric  heating 
pads  are  convenient,  but  the  greatest  care  must  be  exercised  in  their 
use. 


INFAKT   CAKE.  29 

In  summer. — To  promote  comfortable  sleep  in  warm  weather  the 
baby  should  be  very  lightly  dressed,  wearing  nothing  in  addition  to 
his  sleeping  bag  save  a  thin  nightgown,  diaper,  and  gauze  band  after 
the  first  three  months.  Very  young  or  delicate  babies  may  need  the 
shirt  also,  but  this  should  be  of  the  lightest  weight.  The  room  should 
be  made  as  cool  as  possible.  Outdoor  sleeping  is  highly  desirable 
for  all  babies  when  they  can  be  protected  from  flies  and  mosquitoes, 
sufficiently  shielded  from  rain  or  wind,  and  protected  in  case  of 
a  sudden  drop  in  the  temperature.  Indoors,  an  electric  fan  will  keep 
the  air  in  the  room  in  motion  and  thus  relieve  the  oppression  of  the 
heat.  An  oscillating  fan  will  prevent  a  continuous  direct  current  of 
air  from  blowing  on  the  baby. 

Regularity. 

A  baby  should  be  trained  from  the  beginning  to  have  the  longest 
period  of  unbroken  sleep  at  night.  Some  babies  get  a  wrong  start  in 
this  respect  and  make  great  trouble  by  turning  night  into  day.  A 
strong  argument  in  favor  of  the  long  interval  between  feedings  is 
that  it  largely  does  away  with  the  need  for  waking  the  baby  to  nurse. 
Nature  intends  that  the  baby  shall  waken  when  hungry,  and  this 
normally  occurs  about  once  in  3  or  4  hours  in  a  young  healthy  baby, 
so  that  with  a » little  care  the  regular  feeding  interval  can  be  made 
to  coincide  with  the  normal  periods  of  waking.  If  the  baby  is  still 
sound  asleep  when  the  time  for  nursing  has  come,  he  should  be  gently 
roused  and  put  to  breast.  This  will  involve  little  shock  to  his  nerves, 
because  he  will  be  about  ready  to  waken  in  any  event. 

A  mother  who  must  prepare  and  serve  the  evening  meal  of  the 
family  will  find  it  a  great  comfort  to  give  the  baby  his  supper  at 
half  past  5  and  have  him  in  his  crib  at  6.  For  the  first  few  months  he 
will  be  fed  again  about  10  o'clock,  but  after  that  he  should  not  be 
taken  up.  He  must  be  made  comfortable  in  every  way,  the  light 
should  be  put  out,  the  window  opened,  his  covers  adapted  to  the 
temperature,  but  after  the  mother  has  assured  herself  that  every- 
thing essential  to  his  comfort  has  been  attended  to,  if  he  is  a  per- 
fectly healthy  baby,  she  should  not  go  to  him  when  he  cries. 

Disturbed  sleep. 

If  the  baby  sleeps  lightly,  wakens  often,  and  seems  uncomfortable 
he  may  be  nervous  from  having  been  tickled,  played  with,  or  tossed 
about  in  the  latter  part  of  the  day.  Overstimulation  is  to  be  avoided 
at  all  times,  no  matter  what  its  source  nor  what  the  age  of  the  baby. 
It  is  possible  that  he  is  too  warm,  too  cold,  or  wet;  there  may  be 
something  scratching  him,  or  there  may  be  wrinkles  in  the  bed  cloth- 
ing; he  may  be  lying  in  a  cramped  position,  or  the  band  or  diaper 
may  be  too  tight,  or  more  likely,  he  has  been  overfed,  or  has. had 
something  unsuitable  to  eat,  or  is  hungry  or  thirsty.    It  may  be,  also, 


30  INFANT   CARE. 

that  the  room  is  too  hot,  too  cold,  too  light,  too  noisy,  or  not  suffi- 
ciently aired.  The  conditions  which  make  sleep  a  delight  to  older 
persons  affect  the  baby  in  the  same  way,  namely,  plenty  of  fresh  air 
passing  in  a  constant  current  through  the  room,  quiet,  a  clean  body, 
clean,  comfortable  clothing,  a  good  bed,  and  suitable  coverings. 

A  cool  bath  or  a  warm  one,  according  to  the  temperature,  will  help 
to  induce  quiet  sleep.  In  the  summer,  when  the  baby  is  fretful  and 
sleeps  restlessly,  a  tub  bath  at  bedtime  will  help  to  relieve  him.  A 
little  baby  should  be  turned  over  once  or  twice  in  the  course  of  a 
long  nap. 

Many  parents  are  in  the  habit  of  taking  the  children,  even  very 
young  babies,  out  with  them  in  the  evening  to  shop,  to  the  "  movies," 
or  to  visit  friends,  thus  making  a  regular  early  bedtime  an  impossi- 
bility. While  in  many  families  there  is  no  one  to  leave  the  baby  with 
if  father  and  mother  both  go  out,  and  it  is  a  deprivation  if  one  must 
stay  at  home,  the  baby's  welfare  should  be  the  first  consideration.  If 
the  baby  is  taken  out  in  the  evening  his  habit  of  going  to  bed  at  6 
o'clock  is  broken  up ;  he  usually  loses  some  part  of  the  unbroken  sleep 
of  10  or  12  hours  he  needs,  as  he  may  not  sleep  on  in  the  morning  to 
make  up  what  he  lost  the  night  before ;  and  his  eyes  and  nerves  are 
overstimulated  by  the  lights  and  noise.  Furthermore,  he  is  likely  to 
have  been  kept  for  an  hour  or  more  in  a  close,  hot  atmosphere  and 
may  have  been  exposed  to  some  contagious  disease. 

THE  TEETH. 

The  development  of  the  teeth  begins  at  least  six  months  before 
birth.  It  is  probable  that  a  nutritious  diet  for  the  prospective  mother 
lays  the  foundation  for  healthy  teeth  in  the  baby  and  that  lack  of 
proper  food  for  the  mother  may  deprive  both  her  own  and  the  baby's 
teeth  of  some  part  of  their  normal  vigor.4  Every  child  has  two  sets 
of  teeth.  The  first  set,  known  as  the  deciduous  or  "  milk  "  teeth,  are 
replaced,  beginning  at  about  the  sixth  year,  with  the  permanent  or 
"second"  teeth.  Nearly  all  so-called  "teething"  troubles  belong  to 
the  first  period,  as  a  disturbance  is  rarely  connected  with  the  coming 
of  the  permanent  set. 

At  birth  each  tiny  tooth  of  both  sets  lies  partly  embedded  in  a 
cavity  of  the  jawbone,  surrounded  with  and  covered  by  the  softer 
tissues  of  the  gum.  As  the  baby  grows,  the  teeth  grow  also,  and  if 
the  baby  is  healthy  they  are  ready  to  cut  through  the  gums,  begin- 
ning at  about  the  seventh  month  of  life. 

Teething  is  a  normal  process  and  should  not  be  accompanied  by 
any  upset.     Many  children,  however,  do  show  a  slight  disturbance 

4  See  Prenatal  Care,  pp.  8,  9,  "  Diet  during  pregnancy." 


INFANT   CARE. 


31 


at  this  time,  and  a  doctor  should  be  called  to  determine  that  it  is  no 
other  condition  which  is  causing  the  trouble. 


Lower  jaw. 

1.  First  incisor,  6  to  9  months. 

2.  Second  incisor,  12  to  15  months. 

3.  Canine  or  "  stomach,"  18  to  24  months1. 

4.  First  molar,  12  to  15  months. 

5.  Second  molar,  24  to  30  months. 


Upper  jaw. 

1.  First  incisor,  8  to  12  months. 

2.  Second  incisor,  8  to  12  months. 

3.  Canine  or  "  eye,"  18  to  24  months. 

4.  First  molar,  15  months. 

5.  Second  molar,  24  to  30  months. 


Deciduous  or  "  milk  "  teeth. 

The  above  illustrations,  with  the  appended  notes,  show  the  position 
of  the  teeth  in  the  mouth,  their  names,  and  the  approximate  times  of 
their  appearance.  There  are  20  of  the  milk  teeth,  5  in  each  half  jaw. 
The  teeth  appear  in  groups.  There  are  five  of  these  groups,  with 
intervals  between  their  appearance.  After  the  first  group  there  is  a 
pause  of  five  to  eight  weeks ;  after  the  second,  a  pause  of  one  to  three 
months ;  after  the  third,  one  of  from  two  to  three  months ;  after  the 
fourth,  one  of  from  two  to  four  months.  Thus,  by  the  time  a  baby  is 
1  year  old  it  may  have  6  teeth;  at  \\  years  there  should  be  12;  at  2 
years,  16  teeth;  and  at  2J  years  the  entire  set  should  be  cut.  There 
is  considerable  variation,  both  as  to  the  order  in  which  they  appear 
and  in  the  time,  so  that  the  mother  need  not  be  alarmed  if  her  baby 
does  not  follow  the  average  as  above  stated,  but  if  he  has  no  teeth  at 
the  end  of  the  first  year  he  can  hardly  be  said  to  be  developing  prop- 
erly. Probably  the  diet  is  at  fault,  or  some  disease  is  retarding 
growth.  In  such  a  case  the  doctor  should  be  consulted.  Racial  and 
family  traits  account  for  some  of  the  differences. 

This  set  of  teeth  is  replaced  by  the  permanent  set,  beginning 
about  the  sixth  year.  A  child  should  be  taken  to  the  dentist  for 
examination  of  the  first  teeth.  It  sometimes  happens  that  the  milk 
teeth  are  so  firm  they  do  not  fall  out,  but,  remaining  in  the  jaws, 
crowd  back  the  second  set  and  cause  them  to  come  in  misshapen 
and  irregular. 

Growth. 

During  the  second  year  the  baby  should  have  dry,  hard  foods  on 
which  to  chew.  It  is  important  to  the  development  of  strong,  healthy 
teeth  and  jaws  that  they  shall  have  exercise  in  biting  and  chewing. 
There  is  sometimes  a  tendency  to  keep  a  baby  too  long  on  an  ex- 
clusively soft  diet  for  fear  that  solid  food  will  upset  him.     Begin 


/ 

32  INFANT    CAKE. 

by  giving  the  baby  when  about  a  year  old  some  dry,  hard  crust  or 
toast,  or  hard  crackers,  at  the  end  of  a  regular  meal,  but  a  baby 
should  always  be  carefully  watched  when  given  hard  food.  During 
the  second  year  other  kinds  of  food  requiring  chewing  may  be  grad- 
ually added  to  the  diet  list  and  taken  as  part  of  the  regular  meals. 
Care. 

It  is  generally  believed  that  much  of  the  health  of  the  second  teeth 
depends  upon  the  care  that  is  given  to  the  first  set.  At  least  as  soon 
as  the  molars  make  their  appearance,  the  teeth  should  be  gently 
cleaned  each  day  with  a  soft  brush.  As  the  baby  grows  into  child- 
hood he  should  be  taught  the  daily  care  of  his  own  teeth,  although 
no  child  can  be  depended  upon  to  do  this  without  oversight. 

FEET. 

A  very  large  part  of  adult  human  suffering  is  due  to  deformities 
which  have  their  origin  in  infancy  and  childhood,  when  the  bones 
of  the  feet  are  pressed  out  of  shape  by  ill-fitting  shoes.5  Mothers 
should  examine  the  baby's  feet  frequently  for  creases  in  the  soft  flesh 
or  red  spots,  indicating  pressure  from  the  shoes.  The  toenails,  like 
the  'finger  nails,  should  be  cut  square  across,  taking  great  care  not  to 
cut  too  close  to  the  flesh. 

Both  shoes  and  stockings  should  always  be  loose  and  long  enough 
on  the  feet  so  that  the  toes  are  not  crowded.  Probably  the  greatest 
fault  is  to  have  them  too  short,  thus  turning  the  toes  under  or  press- 
ing them  to  one  side.  All  shoes  should  conform  to  the  natural  outlines 
of  the  foot,  with  soles  whose  inner  line  is  nearly  straight  and  which 
allow  an  abundance  of  room  for  the  toes  to  spread  out  flat.  If  the 
toes  are  found  to  be  overlapping,  or  when  creases  or  red  spots  ap- 
pear plainly  on  the  feet,  the  shoes  that  have  caused  the  trouble  should 
be  discarded. 

Patent  leather,  being  covered  with  an  impervious  varnish,  causes 
the  skin  to  perspire,  and  is  entirely  unsuitable  for  children's  shoes, 
save  possibly  for  the  dress-up  shoes  or  slippers  which  are  worn  for  a 
little  while  at  a  time  in  the  house. 

DEVELOPMENT  OF  THE  NORMAL  BABY. 

An  inexperienced  mother  is  often  greatly  at  a  loss  to  know  whether 
a  baby  is  thriving  or  not,  and  may  be  unduly  alarmed  by  small 
matters,  or  may  not  understand  the  serious  nature  of  certain  con- 
ditions. It  may  be  helpful  to  mention  the  leading  characteristics 
of  a  normal,  healthy  baby,  and  the  mother  may  assume  the  lack  of 
these  conditions  to  show  that,  temporarily  or  otherwise,  the  baby  is 

not  in  perfect  health : 

, _ 

5  Directions  for  fitting  shoes  to  a  child's  feet  are  given  in  the  third  bulletin  in  this 
series,  Child  Care :  The  Preschool  Age.  A  copy  will  be  sent  upon  request.  Address 
Children's  Bureau,  U.  S.  Department  of  Labor,  Washington,  D.  C 


INFANT    CARE.    .  <J3 

A  good  appetite. 

Absence  of  vomiting  or  regurgitation. 

Bowel  movements  of  the  normal  number,  color,  and  consistency. 

A  steady  gain  in  weight. 

Clear  skin. 

Bright,  wide-open  eyes. 

Alert,  springy  muscles,  which  respond  readily  to  any  stimulus. 

A  contented  expression. 

Very  little  crying. 

Quiet,  unbroken  sleep,  with  eyes  and  mouth  closed. 

No  evidence  of  pain  or  discomfort. 

A  constant  growth  in  stature  and  intelligence. 

Other  points  in  a  normal  development  are : 

The  soft  spot  at  the  back  of  the  head  closes  at  about  6  weeks,  and 
the  one  on  the  top  when  the  baby  is  from  1J  to  2  years  old. 

Nearly  all  babies  have  blue  eyes  at  birth,  but  the  permanent  color 
appears  in  the  first  few  weeks. 

The  baby  probably  begins  to  recognize  objects  at  about  6  to  8 
weeks,  and  can  focus  his  eyes  on  an  object  when  about  3 
months  old.     He  rarely  sheets  tears  before  this  time. 

Hearing,  in  the  sense  of  knowing  where  a  sound  comes  from,  does 
not  develop  until  the  baby  is  about  2  months  old. 

The  baby  learns  to  hold  up  his  head  when  the  body  is  supported 
during  the  fourth  month. 

He  laughs  aloud  from  the  third  to  the  fifth  month. 

He  reaches  for  toys  and  holds  them  from  the  fifth  to  the  seventh 
month. 

At  7  or  8  months  of  age  he  is  usually  able  to  sit  erect,  and  usually 
creeps. 

During  the  ninth  and  tenth  months  he  makes  the  first  attempts  to 
bear  the  weight  on  the  feet,  and  can  usually  stand  with  assist- 
ance at  11  or  12  months. 

He  begins  to  walk  alone  in  the  twelfth  and  thirteenth  months 
and  walks  alone  at  the  fifteenth  or  sixteenth  month. 

At  1  year  of  age  usually  a  few  words  can  be  spoken,  and  at  the 
end  of  the  second  year  he  makes  short  sentences. 

Normal  children  differ  considerably  in  the  rapidity  of  their  devel- 
opment, some  being  slower  and  some  faster;  therefore  the  mother 
should  not  be  alarmed  at  variations  from  this  statement,  although 
marked  differences  should  put  her  on  guard.  It  is  rarely  wise  to 
push  the  development  of  the  normal  baby. 

HOW  TO  WEIGH  THE  BABY. 

Undress  the  baby  completely.  Put  a  soft  cloth  in  the  pan  of  the 
scales  and  la}^  the  baby  on  it,  or  wrap  the  baby  in  a  blanket  if  the 
room  is  not  warm.  Weigh  carefully  and  write  down  the  result. 
Remove  the  baby,  weigh  the  blanket  or  cloth,  and  subtract  this 
amount  from  the  first  weight. 

When  weighing  the  baby  before  and  after  nursings  to  determine 
the  amount  of  breast  milk  he  is  receiving,  do  not  undress  him,  but 
44527°— 21 3 


34  INFANT   CARE. 

weigh  both  times  in  exactly  the  same  clothing.  If  the  diaper  becomes 
wet  or  soiled  meantime,  do  not  change  it  until  after  the  weight  has 
been  taken.     (See  p.  74  for  normal  weights.) 

OUTDOOR  LIFE. 

Keep  the  baby  out  of  doors.  Except  in  winter,  begin  when  he  is 
2  weeks  old  to  take  him  out  for  a  few  minutes  every  day  in  mild, 
pleasant  weather,  increasing  the  time  gradually  until  he  is  staying 
out  most  of  the  time.  Hardly  anything  will  do  more  to  insure  a 
healthy  babyhood  than  this,  and  the  result  will  Avell  repay  whatever 
trouble  is  necessary  to  secure  it.  With  the  exceptions  mentioned  be- 
low, a  baby  may  spend  practically  all  the  time  out  of  doors,  both 
sleeping  and  waking,  if  there  is  some  one  to  look  after  him  to  see 
that  he  is  protected  against  sun,  wind,  extremes  of  temperature, 
storms,  dangerous  insects,  and  accidents.  A  young  baby  may  stay  in 
his  carriage  or  crib  on  the  porch,  on  the  roof,  under  the  trees,  or  in 
the  back  yard,  where  the  busy  mother  can  look  after  him ;  older  babies 
who  need  exercise  may  be  kept  in  a  creeping  pen  either  on  the  porch 
or  in  the  yard.  (See  p.  35.)  If  it  is  not  feasible  to  provide  outdoor 
sleeping  places,  at  least  the  windows  of  the  nursery  should  be  kept 
wide  open  most  of  the  year. 
When  not  to  take  the  baby  out. 

No  baby  should  go  out  in  below-zero  weather.  When  the  tempera- 
ture is  lower  than  20  degrees  above  zero  (except  during  the  height  of 
bright  days),  or  when  there  is  a  heavy  storm  in  progress  or  a  high 
wind  blowing  quantities  of  dust  about,  it  is  best  to  give  the  baby  his 
airing  indoors  or  on  a  protected  porch.  Dress  him  as  for  going  out, 
open  all  the  windows  wide,  and  let  him  remain  in  the  fresh  air  for 
some  time.  Very  young  or  delicate  babies  require  much  warmth  and 
must  be  well  covered  to  protect  them  from  chill.  A  baby  under  3 
months  of  age  should  not  be  taken  out  in  severe  weather. 

When  it  is  excessively  hot  the  baby  should  be  taken  out  early  in  the 
day,  then  kept  indoors  during  the  hottest  part  of  the  day. 

EXERCISE. 

The  normal  baby  exercises  his  body  constantly.  The  young  baby 
throws  his  arms  and  legs  about  quite  aimlessly;  he  closes  and  un- 
closes his  hands ;  and  stretches  and  twists  his  neck.  As  he  grows,  he 
is  in  almost  constant  motion  during  his  waking  hours  if  he  is  healthy, 
thus  giving  every  muscle  and  bone  in  his  body  the  exercise  it  needs 
for  growth.  A  baby  who  is  "  swaddled,"  or  one  who  is  so  wrapped 
about  with  clothing,  shawls,  and  blankets  that  he  can  not  move  every 
part  of  the  body  freely,  will  be  hampered  in  getting  this  natural 
exercise.    For  this  reason,  also,  the  older  child  should  not  be  left  in 


INFANT   CAKE.  35 

his  high  chair  or  carriage  for  any  length  of  time,  nor  be  fastened  by 
his  clothing  or  bed  covers  in  such  a  way  that  he  can  not  turn  his 
body  or  throw  his  limbs  about  as  he  wishes. 

Creeping  pen. 

A  creeping  pen  affords  the  necessary  protection  and  gives  room  for 
exercise.  It  consists  of  a  fence  made  in  four  sections,  each  18  inches 
high  and  4  feet  long,  hinged  at  three  corners  and  latched  at  the 
fourth.  Beady-made  pens  have  spindles  like  a  stair  rail,  so  that  the 
baby  may  have  something  to  take  hold  of  when  he  tries  to  climb  to 
his  feet.  As  it  folds  together,  the  pen  can  be  readily  moved  about. 
The  floor  of  the  pen  should  have  a  washable  cover  tied  to  the  corners 
by  strong  tapes.  Denim  or  ticking  may  be  used.  A  combination  bed 
and  play  pen,  the  sides  of  which  are  covered  with  wire  netting,  is 
on  the  market.  It  has  also  a  spring  and  mattress  and  is  covered 
below  with  netting.  The  bed  has  a  cover  which  protects  the  baby 
from  flies  and  mosquitoes.  It  is  fitted  with  casters  or  wheels,  so  that 
it  may  be  moved  about  readily.    It  may  be  folded  up  when  not  in  use. 

When  it  is  not  possible  to  purchase  one  of  the  ready-made  articles 
an  ingenious  person  may  devise  a  satisfactory  play  pen  from  mate- 
rials at  hand,  or  a  smooth  board  6  or  8  feet  long  and  a  foot  wide  may 
be  used  to  fence  off  a  sunny  corner  of  the  nursery  for  a  pen. 

Baby  pushers. 

Baby  walkers  should  not  be  used ;  babies  should  not  be  encouraged 
to  walk  until  they  are  quite  ready  for  it.  Too  early  walking  may 
cause  bowlegs ;  also,  the  baby  is  held  for  too  long  a  time  in  a  confined 
space  and  in  a  more  or  less  rigid  position  and  is  easily  overtired.  A 
"  pusher  "  may  be  made  at  home,  which  is  free  from  these  objections. 
This  consists  simply  of  a  small  weighted  platform  made  of  2  by  4 
plank  or  weighted  on  the  under  side  with  a  strip  of  metal  12  inches 
wide  by  18  inches  long,  mounted  on  four  casters.  A  handle  like  that 
on  a  baby  carriage  is  attached  to  the  ends  of  the  platform,  slanting 
backward  so  as  to  come  within  reach  of  the  baby.  He  should  be  able 
to  grasp  it  easily  as  he  stands.  This  contrivance  will  give  him  some 
support  in  learning  to  walk,  yet  he  may  drop  down  to  rest  at  any 
moment. 

Vehicles. 

The  choice  of  a  vehicle  is  a  matter  of  great  importance.  The  fold- 
ing cart,  which  may  be  taken  on  the  street  cars,  permits  mother  and 
baby  to  go  out  many  times  when  it  would  not  otherwise  be  possible. 
The  great  convenience  of  this  cart  can  not  be  denied ;  but  such  carts 
should  be  used  only  for  the  purpose  for  which  they  are  intended, 
namely,  to  convey  the  baby  short  distances,  and  not  as  pleasure 


36  INFANT  CAKE. 

vehicles ;  nor  should  the  baby  be  left  to  sit  in  one  of  these  small  carts 
for  any  great  length  of  time. 

Some  of  the  gocarts  of  the  present  day  are  so  small,  stiff,  and  ill 
adapted  to  the  baby's  anatomy  that  they  can  hardly  be  recommended 
even  for  temporary  use.  Also,  they  are  so  close  to  the  ground  that 
the  child  is  propelled  through  only  the  lower  and  colder  air  cur- 
rents, which  fling  an  unending  stream  of  germ-laden  dust  off  the 
street  into  his  face.  They  frequently  have  no  cover  with  which  to 
shield  the  baby  from  heat  or  cold,  or  sun  or  wind,  and  in  cold  weather 
it  is  impossible  to  keep  him  sufficiently  warm.  The  best  vehicle  for 
ordinary  use  about  the  home  is  one  which  is  at  least  2  feet  high.  It 
should  have  room  for  the  baby,  with  the  necessary  wrappings,  in 
any  position,  and  a  cover  that  can  be  readily  adjusted  to  secure  the 
needed  protection ;  it  should  have  strong,  well-balanced  springs,  and 
stand  squarely  on  four  wheels.  For  the  baby  who  sits  up  a  safety 
strap  which  fastens  about  his  waist  gives  greater  protection  than  the 
ordinary  carriage  strap.  i 

Carriage  outings  which  are,  at  best,  not  an  unmixed  advantage  to 
the  baby,  often  afford  the  only  available  means  for  giving  him  the 
outdoor  air.  The  lack  of  exercise  and  the  more  or  less  rigid  posi- 
tion maintained  for  considerable  periods  of  time  is  wearisome.  Also 
it  is  no  doubt  true  that  a  baby  sent  out  in  charge  of  another  child  or 
of  some  person  not  altogether  competent  to  judge  of  his  comfort  is 
often  neglected.  A  more  wholesome  and  natural  place  to  give  the 
airing  is  in  the  yard  or  on  the  porch,  where  he  can  be  under  the 
mother's  supervision. 

Caution. 

A  word  Ox  caution  is  necessary  as  to  the  danger  of  young  children 
climbing  up  to  open  windows  and  falling  out.  Window  screens  should 
be  so  carefully  fastened  in  that  there  is  no  possibility  of  pushing  them 
out.  When  screens  are  not  in  use,  the  windows  should  either  be 
lowered  from  the  top  or  thin  wooden  slats  should  be  fastened  across 
the  lower  sash.  Similar  precautions  must  be  used  if  the  baby  is  put 
to  sleep  on  the  fire  escape. 

The  baby's  eyes  and  head  should  always  be  carefully  shielded  from 
the  direct  sunlight,  and  this  is  just  as  important  while  he  is  asleep 
as  while  awake.  Do  not  allow  him  to  lie  staring  up  into  the  sky, 
even  when  the  sun  is  not  shining. 

Great  care  should  be  taken  to  protect  the  baby  from  flies  and 
mosquitoes.  If  the  house  is  not  provided  with  screens,  the  bed,  crib, 
or  carriage  should  be  covered  with  netting  suspended  over  a  pole  or 
clothesline  in  the  form  of  a  tent,  so  as  not  to  shut  off  the  air.  Never 
lay  a  netting  in  contact  with  the  baby's  face 


INFANT    CARE.  37 

PLAYING  WITH  THE  BABY. 

A  few  minutes  of  gentle  play  now  and  then  will  not  harm  the  nor- 
mal baby.  A  young,  delicate,  or  nervous  baby  needs  a  great  deal  of 
rest  and  quiet,  and  however  robust  the  child,  much  of  the  play  that 
is  commonly  indulged  in  is  more  or  less  exciting.  It  is  a  great 
pleasure  to  hear  the  baby  laugh  and  crow  in  apparent  delight;  but 
often  the  means  used  to  produce  the  laughter,  such  as  tickling,  punch- 
ing, or  tossing,  make  him  irritable  and  restless. 

The  mother  should  not  kiss  the  baby  directly  on  the  month,  nor 
permit  others  to  do  so,  as  infections  of  various  kinds  are  spread  in 
this  way.  Rocking  the  baby,  jumping  him  up  and  down  on  her 
knee,  tossing  him,  shaking  his  head  or  carriage  disturb  him,  and 
make  him  more  and  more  dependent  upon  these  attentions.  But 
this  is  not  to  say  that  the  baby  should  be  left  alone  too  completely. 
All  babies  need  "  mothering,"  and  should  have  plenty  of  it.  When 
the  young  baby  is  awake  he  should  frequently  be  taken  up  and  held 
quietly  in  the  mother's  arms,  in  a  variety  of  positions,  so  that  no  one 
set  of  muscles  may  become  overtired.  An  older  child  should  be 
taught  to  sit  on  the  floor  or  in  his  pen  or  crib  during  part  of  his 
waking  hours,  or  he  will  be  very  likely  to  make  too  great  demands 
upon  the  mother's  strength.  No  one  who  has  not  tried  it  realizes 
how  much  nervous  energy  can  be  consumed  in  "  minding  "  a  baby 
who  can  creep  or  walk  about,  and  who  must  be  continually  watched 
and  diverted,  and  the  mother  who  is  taking  the  baby  through  this 
period  of  his  life  will  need  to  conserve  all  her  strength,  and  not  waste 
it  in  useless  activity. 

TOYS. 

Since  a  baby  wants  to  put  every  thing  in  his  mouth,  his  toys  must 
be  those  that  can  safely  be  used  in  this  way.  They  should  be  wash- 
able and  should  have  no  sharp  points  nor  corners  to  hurt  the  eyes. 
Painted  articles  and  hairy  and  woolly  toys  are  unsafe,  as  are  also 
objects  small  enough  to  be  swallowed,  and  those  having  loose  parts, 
such  as  bells  and  the  like. 

Rubber  toys,  which  may  be  washed,  are  excellent  for  a  baby. 
Floating  toys  of  celluloid  are  of  great  interest,  but  the  baby  will 
bite  them  to  pieces  unless  he  is  watched. 

A  child  should  never  have  so  many  toys  at  one  time  as  to  distract 
his  interest.  He  will  be  quite  satisfied  with  a  few  things,  and  a  hand- 
ful of  clothespins,  for  example,  will  often  please  just  as  much  as  an 
expensive  doll  or  other  toy.  It  is  an  excellent  plan  to  have  a  box  or 
basket  in  which  to  keep  empty  spools  and  other  household  objects 
which  will  amuse  the  baby. 


38  INFANT   CARE. 

Among  these  articles  are : 

A  string  of  spools. 
A  spoon — wood,  tin,  or  aluminum. 
A  pie  tin  to  pound. 
A  string  of  wooden  beads. 
.     Talcum  powder  cans  (empty). 

Since  everything  goes  into  the  baby's  mouth,  and  all  his  toys  are 
thrown  on  the  floor,  they  should  be  frequently  washed  and,  when 
possible,  boiled,  to  keep  them  sweet  and  clean. 

NURSEMAIDS. 

It  may  be  well  to  speak  a  word  of  warning  as  to  nursemaids.  One 
has  only  to  visit  the  parks  of  any  city  on  a  pleasant  day  to  note  the 
instances  of  neglect  and  carelessness  on  the  part  of  nursemaids 
toward  the  babies  in  their  charge.  Infants  are  allowed  to  lie  with 
the  sun  shining  in  their  eyes ;  are  permitted  to  become  chilled,  tired, 
or  hungry,  or  to  lie  in  wet  diapers;  they  are  scolded  or  jerked  about 
by  one  arm  or  fed  with  candy,  cakes,  or  other  unsuitable  foods  to 
keep  them  contented.  When  at  home  they  may  be  left  strapped  in 
high  chairs  for  long  periods,  or  without  the  mother's  knowledge  may 
be  given  soothing  sirups  or  other  quieting  medicines. 

But  it  is  not  only  in  physical  matters  that  grave  harm  may  be 
done  to  the  baby.  A  nurse  sometimes  threatens  that  the  policeman, 
the  doctor,  or  it  may  be  a  wholly  imaginary  creature  or  person,  will 
come,  if  necessary,  to  enforce  her  will.  It  is  often  almost  impossible 
to  eradicate  fear  instilled  thus  early  in  the  impressionable  mind  of  a 
child.  The  mother  must  be  on  her  guard  to  prevent  this.  A  too 
rigid  obedience  to  the  nurse  should  always  be  viewed  with  suspicion, 
and  although  there  are,  of  course,  many  thoroughly  honest  and 
conscientious  nursemaids,  entirely  devoted  to  the  children  in  their 
care,  no  mother  can  afford  to  run  the  risk  involved  in  neglecting 
to  investigate  the  character  of  the  nursemaid  whom  she  engages. 
Every  nursemaid  should  be  carefully  examined  by  a  physician  as  the 
baby  may  readily  become  infected  from  an  attendant  suffering  from 
communicable  diseases. 

CHILDREN  AS  CARETAKERS. 

In  many  families  the  older  children  are  the  caretakers  of  the  baby, 
and  in  many  cities  the  girls  in  the  grade  schools  are  taught  how  to 
take  good  care  of  the  baby.  Girls  thus  taught  are,  of  course,  of 
very  great  help  to  a  busy  mother.  But  there  is  danger  that  the  time 
for  play  and  pleasures  which  they  need  in  their  own  healthy  growth 
may  be  thus  used.  Mothers  should  remember  that  young  boys  and 
girls  absolutely  need  a  certain  amount  of  free  play,  preferably  out 


INFANT   CARE.  39 

of  doors,  unless  they  are  to  be  stunted  and  weakened,  and  should 
see  that  they  are  not  imposed  upon  by  the  too  constant  care  of  a 
baby.  They  should  also  remember  that  a  fat  baby  is  a  heavy  load 
for  anyone  to  carry,  and  that  the  slender  frame  and  tender  bones  and 
muscles  of  a  young  girl  may  be  easily  bent  and  injured  by  lifting 
and  carrying  the  baby.  On  the  other  hand,  older  sisters  and  brothers 
may  very  well  learn  to  look  after  the  baby  some  part  of  every  day 
or  to  take  him  out  in  his  carriage  while  the  mother  has  a  chance 
to  rest  or  to  go  out.  When  necessary,  written  directions  for  par- 
ticular care  should  be  left  by  the  mother,  but  the  general  rules 
regarding  the  baby's  food,  sleep,  and  airings  should  be  the  common 
knowledge  of  the  whole  family. 

THE  BABY'S  VACATION. 

In  the  early  summer  the  trains  and  boats  carry  thousands  of 
families  to  the  seashore,  the  mountains,  or  the  farms  for  their  annual 
vacations  from  the  hot  and  crowded  cities.  Whether  this  change 
from  city  to  country  life  is  beneficial  or  not  depends  largely  upon 
the  sort  of  living  conditions  into  which  the  children  go,  the  character 
of  the  milk  and  water  supplies,  and  the  sanitary  standards  of  the 
place.  The  mother  should  select,  if  possible,  a  place  where  a  water 
closet  or  some  other  form  of  sanitary  privy  is  in  use.  In  going  to  a 
new  place,  it  is  best  to  boil  all  the  drinking  water  and  the  milk  for  the 
baby.  The  doors  and  windows,  and,  if  possible,  the  porches,  should 
be  screened.  If  the  house  is  not  screened  the  mother  should  use  a 
cotton  netting  in  order  that  the  baby's  crib,  at  least,  may  be  protected 
from  insects. 

Traveling  with  young  children. 

If  a  trip  with  young  children  is  an  absolute  necessity  it  should 
be  carefully  planned.  Berths  and  seats  should  be  reserved  in  ad- 
vance and  accurate  information  as  to  leaving  and  arriving  times  of 
all  the  trains  and  boats  concerned  should  be  secured.  The  easiest 
child  to  tray  el  with  is  the  young  breast-fed  baby.  His  food  is  all 
ready  for  him,  and  usually  he  sleeps  most  of  the  time.  The  older, 
restless,  bottle-fed  baby  presents  the  greatest  problem.  His  milk 
should  be  prepared,  boiled,  and  packed  in  ice  before  starting  on  the 
journey,  unless  powdered  or  condensed  milk  is  used.     (See  p.  64.) 

To  sterilize,  stand  the  filled  bottles  in  a  kettle  over  the  fire  and  let 
the  water  boil  about  them  for  an  hour  and  a  half .  After  boiling,  the 
bottles  should  be  cooled  as  rapidly  as  possible  and  then  chilled  by 
standing  them  in  a  pail  of  cracked  ice.  They  may  then  be  packed 
in  a  small  portable  refrigerator.     Many  types  of  these  have  been 


40  I]STFAXT    CARE. 

devised  and  may  be  purchased,  but  a  simple  ice  box  may  be  made 
at  home  as  follows: 

Use  two  covered  tin  pails,  one  an  inch  or  two  smaller  than  the 
other,  so  that  it  may  stand  inside  the  larger  pail.  Fill  the  space  be- 
tween the  two  with  sawdust,  put  the  bottles  with  cracked  ice  in  the 
inner  pail;  cover  both  tightly,  and  make  a  canvas  or  flannel  cover 
for  the  whole.  For  a  24-hour  trip,  milk  may  be  carried  in  a  vacuum 
bottle  if  desired.  The  milk  should  be  boiled,  then  thoroughly  chilled 
before  being  put  into  the  bottle  which  must  be  thoroughly  cleaned 
and  scalded.  Each  feeding  bottle  must  be  filled  and  warmed  as 
needed. 

To  warm  the  bottle  for  the  baby,  the  mother  should  provide  herself 
with  an  enameled- ware  pitcher  holding  a  pint,  which  the  porter  will 
fill  with  hot  water  from  the  dining  car.  Stand  the  bottle  in  it  to 
heat  after  the  water  has  cooled  a  little  so  that  the  sudden  heat  will 
not  be  sufficient  to  break  the  bottle.  A  bottle  warmer  with  a  small 
stove  heated  by  solid  alcohol  may  be  safely  used  on  a  journey.  A 
metal  tray  should  always  be  used  under  the  lamp. 

Dry  milk  is  satisfactory  to  use  for  travel.     (See  p.  64.) 

A  separate  bag  or  basket  lined  with  rubber  sheeting  should  be 
provided  for  the  diapers,  and  with  them  may  be  packed  a  small 
enameled-ware  chamber.  For  a  young  baby  a  number  of  inner  pads 
of  soft  paper  or  old  cloth  which  can  be  destroyed  should  be  provided. 
When  one  of  these  is  soiled,  wrap  it  in  newspaper  and  destroy  it. 
Wet  diapers  may-be  tightly  rolled  and  kept  in  the  rubber  bag. 

In  the  hot  summer  weather,  for  a  long  journey,  the  older  baby 
should  be  dressed  only  in  the  sleeveless  gauze  shirt  and  diaper,  with 
one  thin  outer  garment.  A  short-sleeved,  low-necked  slip  of  white 
china  silk  is  cooler  than  cotton,  sheds  the  dust,  and  can  be  washed 
out  in  the  basin  when  soiled.  Warmer  clothing  should  be  at  hand 
to  slip  on  at  once  if  the  day  suddenly  cools. 

It  is  well  to  change  the  baby's  clothing  as  soon  as  the  journey 
begins  in  order  to  have  the  regular  outfit  clean  to  put  on  when  leav- 
ing the  train.  The  little  baby  may  go  barefooted,  but  an  older  child 
should  have  barefoot  sandals  to  protect  the  feet  from  the  cinders 
scattered  over  the  floor. 

The  usual  regular  hours  for  feeding  the  baby  should  be  observed. 
Mothers  sometimes  give  the  baby  cakes,  candy,  bananas,  sweet  crack- 
ers, and  the  like,  to  keep  him  quiet  in  the  train.  Irregular  feeding 
with  unsuitable  foods,  together  with  the  fatigue  and  excitement  of 
traveling,  are  very  apt  to  make  the  baby  irritable  if  not  actually  ill. 

CARE  OF  THE  CITY  BABY. 

Taking  care  of  a  baby  is  made  more  difficult  for  the  city  mother 
by  overcrowded  houses,  lack  of  fresh  air,  sunshine,  and  open  spaces 


INFANT   CAEE.  41 

for  play  and  out-of-door  life.  This  is  particularly  true  in  hot 
weather.  During  the  summer  months  in  most  of  the  larger  cities 
there  is  an  enormous  increase  in  sickness  among  babies,  many  of 
whom  fail  to  survive  this  period.  These  well-known  facts  have  led 
to  the  establishment  in  many  cities  of  what  are  known  as  health 
centers.  These  rooms  are  in  charge  of  trained  nurses  and  physicians, 
and  any  mother  who  desires  may  bring  her  baby  for  examination 
and  advice,  Nurses  are  sent  out  from  these  stations  to  teach  and 
advise  mothers  in  their  homes. 

The  object  of  these  centers  is  to  keep  babies  well  by  watching  them 
closely  and  by  teaching  the  mothers  how  to  take  care  of  them.  If  a 
baby  is  found  to  be  sick  the  mother  is  referred  to  her  own  physician, 
if  she  has  one.  If  not,  she  is  usually  sent  to  a  dispensary.  The  prin- 
cipal factor  in  keeping  the  baby  well  is  to  have  him  properly  fed. 
Accordingly,  the  physician  who  cares  for  the  baby  should  direct  this 
very  carefully.  If  the  mother  has  no  physician,  the  station  doctor 
will  examine  the  baby  and  order  a  diet  for  him.  The  nurse  assists 
the  mother  in  f  ollowing  out  his  directions,  and  visits  her  in  her  home 
for  this  purpose.  These  stations  are  sometimes  maintained  by  the 
city  and  sometimes  by  a  private  society.  The  mother  can  find  out 
the  location  of  the  station  nearest  her  home  by  inquiring  at  the  city 
health  office. 

CARE  OF  THE  COUNTRY  BABY. 

The  country  mother  is  now  able,  in  many  places,  to  have  the  help 
and  advice  of  a  county  or  community  public  health  nurse.  Frequent 
health  consultations,  held  at  fairs,  or  at  the  county  seat,  or  in  other 
centers,  as  well  as  the  traveling  clinic  and  consultation  car,  are  all 
beneficial  agencies  which  are  becoming  more  and  more  usual  in  rural 
districts  of  many  States. 

SUPERSTITIONS. 

Many  superstitions  have  grown  up  around  the  mother  and  the 
baby.  Some  of  these  have  had  their  origin  in  long  past  ages ;  others 
spring  up  from  time  to  time.  Most  of  these  beliefs  are  of  no  value, 
and  niany  are  silly,  even  dangerous.  One  of  these  foolish  traditions 
is  that  biting  (instead  of  cutting)  the  baby's  finger  nails  will  prevent 
him  from  becoming  a  thief.  Another,  that  his  condition  is  affected 
by  the  phase  of  the  moon ;  another,  that  wearing  charms  and  amulets 
of  various  kinds  will  ward  off  disease,  or  that  ill  luck  will  follow  if 
the  baby  looks  in  the  glass.  No  modern  mother,  intelligent  enough  to 
read,  should  allow  herself  to  be  influenced  by  any  of  these  or  similar 
tales.  The  proper  care  of  the  baby  consists  in  applying  certain  scien- 
tific health  principles  which  have  been  reduced  to  working  rules  by 
specialists  and  made  available  for  all  mothers.    These  fundamental 


42  INFANT  CARE. 

rules  are  not  shrouded  in  any  sort  of  mystery.  They  are  plain  and 
easy  to  understand  and  may  be  learned  and  used  by  the  average 
mother. 

It  frequently  happens  that  a  young  mother  has  so  much  advice 
from  earnest  and  entirely  well-meaning  friends  that  she  is  bewildered, 
especially  when  one  person's  directions  conflict  with  those  of  another. 
In  some  cases,  of  course,  this  advice  may  be  of  the  wisest  and  best ; 
but  in  all  cases  she  should  have  some  standards  of  her  own  against 
which  to  measure  what  she  is  told.  Her  physician  and  nurse  should 
be  her  first  guides;  later,  in  addition,  she  should  have  at  least  one 
book  of  recognized  value  to  consult  when  she  is  in  doubt.  The  proper 
development  of  the  average  baby  follows  a  normal  course ;  and,  when 
the  baby's  growth  is  not  proceeding  as  it  should,  the  doctor  should  be 
consulted  and  his  advice  carefully  followed.  Above  all,  the  baby 
should  not  be  experimented  upon  first  with  one  mode  of  care  and  then 
another,  in  accordance  with  the  various  opinions  offered.  Baby  care 
is  a  great  art  and  a  great  science ;  it  is  also  the  most  important  task 
any  woman  ever  undertakes,  and  she  should  apply  to  this  work  the 
same  diligence,  intelligence,  and  sustained  effort  that  she  would  give 
to  the  most  exacting  profession.  It  will  only  be  when  the  profession 
of  parenthood  is  thus  dignified  that  children  will  come  into  their  full 
inheritance  of  health,  efficiency,  and  happiness. 

HABITS,  TRAINING,  AND  DISCIPLINE. 

Habits  are  the  result  of  repeated  actions.  The  wise  mother  strives 
to  start  the  baby  right.  A  properly  trained  baby  is  not  allowed  to 
learn  bad  habits  which  must  be  unlearned  later  at  great  cost  of  time 
and  patience. 

Systematic  care. 

In  order  to  establish  good  habits  in  the  baby,  the  mother  must 
know  what  they  are  and  how  to  induce  them.  Perhaps  the  first  and 
most  essential  good  habit  is  that  of  regularity.  This  begins  at  birth 
and  applies  to  all  the  physical  functions  of  the  baby — eating,  sleep- 
ing, and  bowel  movements.  The  care  of  a  baby  is  readily  reduced  to 
a  system  unless  he  is  sick.  Such  a  system  is  not  only  one  of  the 
greatest  factors  in  keeping  the  baby  well  and  in  training  him  in  a 
way  which  will  be  of  value  to  him  all  through  life,  but  it  also  reduces 
the  work  of  the  mother  to  the  minimum  and  provides  for  her  certain 
assured  periods  of  rest  and  recreation. 

Training  the  bowels. 

This  may  be  begun  as  early  as  the  end  of  the  first  month. 
The  first  essential  in  bowel  training  is  absolute  regularity.     As 
soon  as  the  mother  takes  charge  of  her  baby  after  confinement  she 


INFANT    CARE.  43 

should  begin  upon  this  task.  It  is  one  which  requires  unlimited 
patience,  but  the  result  is  well  worth  the  effort  involved.  xilmost 
any  baby  can  be  so  trained  that  there  are  no  more  soiled  diapers  to 
wash  after  he  is  a  year  old,  and  many  mothers  accomplish  the  result 
much  earlier  than  this.  The  habit  of  regular  evacuation  thus  estab^ 
lished  in  infancy  will,  if  persisted  in  through  the  growing  years, 
save  endless  misery  from  constipation  in  the  adult.  The  mother 
should  observe  the  hour  at  which  the  baby  soils  his  diaper.  At  the 
same  hour  the  next  day  she  should  hold  him  over  the  chamber,  using 
a  soap  stick,  if  necessary,  to  start  the  movement,  and  thus  continue 
day  after  day,  not  varying  the  time  by  five  minutes,  until  the  baby 
is  fixed  in  this  habit.  As  the  baby  grows  he  can  be  taught  to  grunt, 
to  bear  down  a  little,  or  to  show  his  desire  by  some  other  sign. 

This  training  is  begun  by  different  methods.  One  of  these  is  as 
follows : 

The  baby  should  be  held  on  the  mother's  lap,  or  laid  on  a  table  with 
his  head  toward  her  left,  in  the  position  assumed  for  changing  the 
diaper.  The  feet  should  be  lifted  with  the  left  hand  while  a  soap 
stick  6  or  other  suppository  is  inserted  into  the  rectum  with  the  right 
hand.  Still  holding  the  feet  up,  press  a  small  chamber  gently  against 
the  buttocks  and  hold  it  there  until  the  stool  is  passed.  The  stool  will 
come  in  a  few  minutes. 

Another  method  is  to  hold  the  chamber  in  the  lap  and  place  the 
baby  over  it  with  his  back  against  the  mother's  chest.  This  makes  it 
possible  for  the  mother  to  support  the  young  baby  before  he  is  strong 
and  able  to  sit  alone.  As  soon  as  a  baby  is  able  to  sit  up  and  hold 
himself  he  should  be  taught  the  use  of  the  nursery  chair. 

A  convenient  time  for  a  stool  is  just  before  undressing  for  bathing. 

After  the  first  three  or  four  days,  or  as  soon  as  possible,  omit  the 
suppository.  At  first  it  will  be  necessary  to  wait  longer  for  the  stool, 
possibly  five  or  ten  minutes. 

This  training  will  require  much  time  and  patience  on  the  part  of  the 
mother,  but,  in  the  end,  the  habit  thus  formed  will  be  a  great  saving 
of  trouble  to  her  and  of  untold  value  to  the  child,  not  only  in  baby- 
hood but  also  throughout  the  whole  of  life. 

Training  the  bladder. 

It  takes  longer  to  teach  the  baby  the  control  of  his  bladder,  but 
the  method  to  be  followed  is  the  same  as  with  the  bowel  training. 
The  baby  should  be  given  the  chamber  very  often,  perhaps  once  an 

6  To  make  a  soap  stick  take  a  piece  of  firm  white  soap  half  an  inch  thick  and  about 
2  inches  long  and  shave  it  down  toward  one  end  until  the  point  is  about  one-quarter  of  an 
inch  thick  and  rounded  perfectly  smooth.  Wet  the  soap  stick  or  dip  it  in  vaseline  before 
using  it.  Hold  the  stick  by  the  thick  end,  insert  the  other  end  in  the  rectum.  Gluten, 
cocoa  butter,  or  glycerin  suppositories  may  be  purchased  at  a  drug  store  and  are  accom- 
panied by  directions  for  their  use.  Glycerin  suppositories  are  too  irritating  for  continued 
use  with  a  baby. 


44  INFANT    CARE. 

hour,  at  least,  while  awake,  and  gradually  led  to  indicate  his  desire. 
One  device  for  teaching  the  baby  not  to  wet  is  to  put  him  into  draw- 
ers very  young,  discarding  the  diaper  much  earlier  than  is  usually 
done.  The  warm,  thick  diaper  constantly  suggests  to  the  baby  the 
idea  of  wetting  and  no  doubt  retards  his  training  in  this  regard,  He 
will  not  like  the  feeling  of  the  wet,  cold  drawers,  and  there  will 
be  nothing  about  them  to  suggest  wetting,  but  rather  the  reverse. 

Cleanly  habits. 

Children  should  be  taught  very  early  that  it  is  not  safe  to  use  a 
handkerchief  that  has  been  used -by  someone  else,  and  for  similar 
reasons  the  use  of  individual  towels  and  wash  cloths  should  be  in- 
sisted upon.  Every  effort  should  also  be  made  to  teach  a  child  to 
keep  his  fingers  out  of  his  mouth  and  nose. 

Bad  habits. 

Some  of  the  bad  habits  which  a  baby  learns  are  these . 

Crying. — Crying  should  not  be  classed  as  a  bad  habit  without  some 
modification,  for  although  a  well  baby  does  not  cry  very  much,  he 
has  no  other  means  of  expressing  his  needs  in  the  early  months  of 
life,  and  his  cry  ought  to  be  heeded.  But  when  he  cries  simply 
because  he  has  learned  from  experience  that  this  brings  him  what 
he  wants,  it  is  one  of  the  worst  habits  he  can  learn,  and  one  which 
takes  all  the  strength  of  the  mother  to  break.  Crying  should  cease 
when  the  cause  has  been  removed.  If  the  baby  cries  persistently  for 
no  apparent  cause,  the  mother  may  suspect  illness,  pain,  hunger,  or 
thirst.  The  first  two.  of  these  causes  will  manifest  other  symptoms, 
and  the  actual  need  for  food  may  be  discovered  by  frequent  weighing. 
But  if,  after  careful  scrutiny  of  all  these  conditions,  no  cause  for  the 
crying  can  be  found,  the  baby  probably  wants  to  be  taken  up,  walked 
with,  played  with,  rocked,  or  to  have  a  light,  or  to  have  some  one  sit 
by  him — all  the  result  of  having  learned  that  crying  will  get  him 
what  he  wants,  sufficient  to  make  a  spoiled,  fussy  baby,  and  a  house- 
hold tyrant  whose  continual  demands  make  a  slave  of  the  mother. 
It  is  difficult  to  break  up  this  habit  after  it  has  once  been  formed,  but 
it  can  be  done.  After  the  baby's  needs  have  been  fully  satisfied  he 
should  be  put  down  alone  and  allowed  to  cry  until  he  goes  to  sleep. 
This  may  sound  cruel,  and  it  is  very  hard  for  a  young  mother  to  do, 
but  it  will  usually  take  only  a  few  nights  of  this  discipline  to  accom- 
plish the  result.  In  some  cases  persistent  crying  may  be  due  to 
causes  not  readily  discernible  by  the  mother ;  in  this  event,  the  opinion 
of  a  good  doctor  as  to  the  cause  of  the  crying  should  be  sought. 
There  is  little,  if  any,  danger  that  crying  will  cause  rupture. 

"Pacifiers'"  or  "comforts." — The  extremely  bad  habit  of  sucking 
on  a  rubber  teat,  or  a  sugar  ball,  or  a  bread  ball,  or  any  other  article 
is  one  for  which  some  one  else  is  entirely  responsible-     The  baby  does 


infaxt  care.  45 

not  teach  himself  this  disgusting  habit,  and  he  should  not  have  to 
suffer  for  it.  Some  of  the  evil  effects  ascribed  to  this  habit  are  that  it 
spoils  the  natural  arch  of  the  mouth  by  causing  the  protrusion  of  the 
upper  jaw;  it  induces  a  constant  flow  of  saliva  and  keeps  the  baby 
drooling ;  the  pacifier  is  never  clean  and  may  readily  carry  the  germs 
of  disease  into  the  baby's  mouth;  and  last  and  least,  it  is  a  habit 
which  is  particularly  disfiguring  to  the  baby's  appearance.  No  such 
object  should  ever  be  permitted  in  the  baby's  mouth. 

Thumb  or  -finger  sucking. — This  is  another  habit  leading  to  the 
same  results  as  the  use  of  pacifiers,  but  one  which  the  baby  may 
acquire  for  himself,  although  it  is  frequently  taught  to  him.  To" 
break  up  either  habit  requires  resolution  and  patience  on  the  part  of 
the  mother.  The  thumb  or  finger  must  be  persistently  and  constantly 
removed  from  the  mouth  and  the  baby's  attention  diverted  to  some- 
thing else.  The  sleeve  may  be  pinned  or  sewed  down  over  the  fingers 
of  the  offending  hand  for  several  days  and  nights,  or  the  hand  may 
be  put  in  a  mitten  made  from  drilling  or  other  hard  cloth.  Ill-tast- 
ing applications  have  very  little  effect.  There  are  patent  articles 
sold  in  the  stores  for  keeping  the  hand  from  the  mouth ;  also  celluloid 
cuffs  which  make  it  impossible  for  the  baby  to  bend  his  arms  at  the 
elbow,  but  the  persistent  covering  of  the  hand  often  works  very  well. 
It  should  be  set  free  now  and  then,  especially  if  the  baby  is  old 
enough  to  use  his  hands  for  his  toys,  and  at  meal  times,  to  save  as 
much  unnecessary  strain  on  his  nerves  as  possible,  but  at  bed  or  nap 
time  the  hand  must  be  covered. 

Bed  wetting. — It  requires  great  patience  and  persistence  on  the 
mother's  part  to  teach  the  baby  to  control  the  bladder.  Some  babies 
may  be  taught  to  do  this  during  the  day  by  the  end  of  the  first  year, 
but  it  is  ordinarily  not  until  some  time  during  the  second  year  that 
it  is  accomplished.  Few  habits  among  older  babies  and  young  chil- 
dren, as  well  as  older  ones,  are  so  vexatious,  so  difficult  to  cure,  and 
so  consuming  of  time  as  that  of  bed  wetting.  In  some  older  children 
this  habit  may  be  due  to  nervous  troubles  of  various  kinds,  but  in 
the  great  majority  of  cases  it  is  merely  the  carrying  over  of  the 
infantile  habit  into  childhood  because  of  the  lack  of  early  and  per- 
sistent training  in  bladder  control.  Mothers  who  realize  this  will 
know  that,  whatever  the  trouble  involved  in  the  training,  it  is  noth- 
ing compared  to  the  annoyance  caused  by  this  habit,  and  will  there- 
fore be  reconciled  to  the  task.  If  it  persists  in  children  3  years  old 
and  over,  bed  wetting  may  be  due  to  some  physical  weakness  and  a 
doctor  should  be  consulted.  In  ordinary  cases  it  may  suffice  if  no 
liquid  food  is  given  in  the  late  afternoon  and  if  the  baby  is  taken  up 
the  last  thing  before  the  mother  retires. 

Masturbation. — This  is  a  common  habit  among  children,  practiced 
by  rubbing  the  genitals  with  the  hands,  or  by  rubbing  against  various 


46  INFANT   CARE. 

objects.  If  the  baby  is  seen  to  be  carrying  on  this  habit  every  effort 
should  be  made  to  break  it  up  as  soon  as  possible,  as  it  grows  worse 
if  left  uncontrolled.  It  may  be  due  to  lack  of  cleanliness,  or  to  some 
local  condition  which  irritates  the  sensitive  parts;  and,  for  this  rea- 
son, it  is  well  to  have  the  baby  examined  by  the  doctor.  The  treat- 
ment consists  almost  entirely  in  imposing  mechanical  restraints,  and 
in  great  attention  to  keeping  the  parts  clean.  Wet  or  soiled  diapers 
should  be  removed  at  once  and  the  parts  made  clean  and  dry.  A 
thick  towel  or  pad  may  be  used  to  keep  the  thighs  apart  while  the 
baby  is  asleep,  and  the  hands  may  be  restrained  by  pinning  the  night- 
•  gown  sleeves  loosely  to  the  lower  sheet  when  putting  the  baby  down 
for  the  night.  Such  a  baby  should  not  be  left  awake  alone  in  bed. 
Constant  and  patient  watchfulness  on  the  mother's  part  are  required 
to  break  up  this  habit.    Punishment  is  worse  than  useless. 

Punishment. 

Harsh  punishment  has  no  place  in  the  proper  upbringing  of  the 
baby.  A  baby  knows  nothing  of  right  or  wrong,  but  follows  his  nat- 
ural inclinations.  If  these  lead  him  in  the  wrong  direction  the 
mother  must  be  at  hand  to  guide  him  in  another  and  better  one  and 
to  divert  his  eager  interest  and  his  energy  into  wholesome  and  nor- 
mal directions.  This  is  the  golden  rule  in  the  training  of  babies,  and 
one  which  applies  to  the  training  of  children  of  all  ages.  Many  par- 
ents conceive  that  their  whole  duty  is  to  thwart  and  forbid,  enforcing 
their  prohibitions  with  penalties  of  varying  degrees  of  severity,  for- 
getting that  they  are  dealing  with  a  sensitive  being  endowed  with  all 
the  desires,  inclinations,  and  tendencies  that  they  themselves  have, 
and  that  if  these  natural  feelings  are  continually  suppressed  and 
thwarted  they  are  sure  to  seek  and  find  some  outlet  for  themselves. 
A  child  who  is  often  punished  may  be  so  dominated  by  fear  of  his 
parents  that,  the  natural  expression  of  his  vital  interests  being  denied 
him,  he  becomes  sullen  and  morose  as  he  grows  older. 

Early  training. 

The  training  in  the  use  of  individual  judgment  can  be  begun  even 
in  infancy ;  a  child  should  early  be  taught  to  choose  certain  paths  of 
action  for  himself ;  and  if  he  is  continually  and  absolutely  forbidden 
to  do  this  or  that  he  is  sometimes  seriously  handicapped  later,  because 
he  does  not  know  how  to  use  his  own  reasoning  faculties  in  making 
these  choices.  On  the  other  hand,  obedience  is  one  of  the  most  neces- 
sary lessons  for  children  to  learn.  A  wise  mother  will  not  abuse  her 
privilege  in  this  respect  by  a  too-exacting  practice.  For  the  most 
part  she  can  exert  her  control  otherwise  than  by  commands,  and  if 
she  does  so  her  authority  when  exercised  will  have  greater  force,  and 
instant  obedience  will  be  more  readily  given. 


INFANT    CARE.  47 

Most  of  the  naughtiness  of  infancy  can  be  traced  to  physical 
causes.  Babies  who  are  fussy,  restless,  and  fretful  are  usually  either 
sick  or  ailing,  have  not  been  properly  fed  and  cared  for,  or  have 
been  indulged  too  much.  On  the  other  hand,  babies  who  have  the 
right  food,  who  are  kept  clean  and  have  plenty  of  sleep  and  fresh 
air,  and  who  have  been  trained  in  regular  habits  of  life,  have  no 
cause  for  being  "  bad  "  and  are  therefore  "  good." 

It  must  not  be  forgotten  that  infancy  is  a  period  of  education  often 
of  greater  consequence  than  any  other  two  years  of  life.  Not  only 
are  all  the  organs  and  functions  given  their  primary  training,  but  the 
faculties  of  the  mind  receive  those  initial  impulses  that  determine 
very  largely  their  direction  and  efficiency  through  life.  The  first  nerv- 
ous impulse  which  passes  through  the  baby's  eyes,  ears,  fingers,  or 
mouth  to  the  tender  brain  makes  a  pathway  for  itself ;  the  next  time 
another  impulse  travels  over  the  same  path  it  deepens  the  impression 
of  the  first.  It  is  because  the  brain  is  so  sensitive  to  these  impressions 
in  childhood  that  we  remember  throughout  life  things  that  have  hap- 
pened in  our  early  years  while  nearer  events  are  entirely  forgotten. 
If,  therefore,  these  early  stimuli  are  sent  in  orderly  fashion,  the 
habit  thus  established  and  also  the  tendency  to  form  such  habits  will 
persist  throughout  life. 

BREAST  FEEDING. 

IMPORTANCE  OF  BREAST  FEEDING. 

The  food  necessary  for  the  normal,  healthy  development  of  every 
infant  mammal,  including  the  human  species,  is  created  for  it  in  the 
breast  of  its  mother.  The  milk  of  each  animal  is  different  from  that 
of  every  other,  and  each  is  especially  adapted  to  the  needs  of  the 
young  of  that  species. 

The  first  year  of  life  is  the  year  of  greatest  growth  and  develop- 
ment. The  baby  must  adapt  himself  to  entirely  new  conditions.  All 
his  organs  must  learn  to  function.  The  way  a  baby  is  fed  during 
this  period  either  helps  him  to  live  and  to  become  strong  and  healthy, 
or  makes  his  growth  and  development  much  more  difficult.  Breast 
feeding  helps  him  more  than  any  other  one  thing. 

Breast  feeding  provides  the  substances  exactly  adapted  to  produce 
normal  growth  and  development,  besides  being  the  cheapest  and  most 
convenient  way  to  nourish  a  baby.  There  is  no  food  "  just  as  good  " 
as  mother's  milk.  Mother's  milk  prevents  certain  diseases  and  pro- 
tects the  baby  from  others. 

The  death  rate  of  infants  who  are  breast  fed  for  the  first  months 
of  life  is  much  lower  than  among  babies  who  are  artificially  fed 
during  this  period.  If  every  mother  realized  how  perilous  the  first 
months  after  birth  are  to  her  infant,  and  how  great  a  protection 


48  INFANT    CAKE. 

breast  feeding  is,  few  babies  would  be  artificially  fed,  and,  as  a 
result,  the  number  of  infant  deaths  would  be  greatly  lessened. 

Practically  every  mother,  with  proper  instruction  as  to  the  care 
of  her  own  health,  can  nurse  her  baby  and  thus  provide  him  the  food 
exactly  adapted  to  his  needs.  Only  protracted  maternal  illness  of 
an  infectious  nature  should  prevent  her  from  nursing  her  baby. 

PRODUCTION  OF  BREAST  MILK. 

The  first  secretion  of  the  breasts,  called  "  colostrum,"  is  a  thick, 
yellowish  fluid  which  is  adapted  to  the  first  needs  of  the  baby.  It  is 
important  to  put  the  baby  to  the  breast  at  regular  intervals,  as  this 
stimulates  the  production  of  true  milk. 

Colostrum  changes  gradually  into  true  milk,  which  is  thinner  and 
bluer.     Usually  the  milk  flow  is  well  established  after  a  week. 

As  the  child  grows  the  amount  of  milk  secreted  gradually  increases 
in  response  to  his  demands.  At  the  beginning  of  a  nursing  some 
milk  is  in  the  breast,  but  most  of  it  is  actually  formed  during  the 
act  of  nursing.  The  quantity  which  the  baby  obtains  at  a  feeding 
depends  largely  on  the  vigor,  strength,  and  persistence  with  which 
the  infant  sucks.  Emptying  the  breast  completely  by  regular  nurs- 
ing helps  more  than  anything  else  to  produce  milk. 

The  amount  and  quality  of  milk  produced  depends  not  only  upon 
the  demands  of  the  baby,  but  also  on  the  diet  and  hygiene  of  the 
mother. 

The  length  of  the  period  during  which  the  mother  produces  milk 
varies  considerably.  Women  of  certain  races  nurse  their  babies 
much  longer  than  others;  also,  circumstances  may  lengthen  or 
shorten  this  period.  Many  women  can  nurse  their  babies  at  least 
a  year,  but  the  average  infant  usually  needs  additional  food  after 
the  sixth  month,  although  if  gaining  satisfactorily  this  may  not  be 
necessary  before  the  eighth  or  ninth  month. 

CARE   OF  THE  NURSING  MOTHER. 
Diet. 

While  the  mother  is  in  bed  she  should  have  a  light,  nourishing,  va- 
ried diet  of  not  more  than  four  meals  in  24  hours.  After  the  mother  is 
out  of  bed  she  may  then  take  her  accustomed  diet,  provided  it  is  suffi- 
ciently nutritious.  A  nursing  mother  needs  an  abundance  of  good, 
simple,  nourishing  food.  It  is  usually  best  for  her  to  take  food  only  at 
meal  times  and  to  take  nothing  but  water  between  meals.  Eating  be- 
tween meals  usually  upsets  the  stomach  and  in  the  end  the  mother  gets 
actually  less  nourishment  than  if  she  eats  only  four  regular  meals. 
The  meals  should  be  simple  and  well  cooked,  and  at  the  end  of  each 


INFANT    CAEE.  49 

meal  the  mother  should  drink  a  large  glass  of  milk.  The  fourth  meal, 
at  bedtime,  should  consist  of  milk  or  a  bowl  of  corn  meal  or  other 
gruel,  or  some  other  simple,  easily  digested  food.  One  quart  of  milk 
in  some  form  and  one  quart  of  water  should  be  taken  daily.  One  cup 
of  coffee  or  tea  a  day  at  mealtime  is  allowable. 

The  mother  may  eat  anything  she  can  easily  digest.  The  old- 
fashioned  belief  that  nursing  mothers  can  not  take  certain  foods, 
such  as  acid  fruits  or  vegetables,  for  fear  of  upsetting  the  baby,  is  no 
longer  held.  Occasionally  a  certain  food  may  distress  a  particular 
baby.  When  this  has  been  proved  it  should  be  eliminated  from  the 
mother's  diet. 

Bowels. 

Constipation  is  very  common  in  the  case  of  the  nursing  mother 
and  must  be  guarded  against.  The  excessive  use  of  cathartics 
may  cause  diarrhea  in  the  baby.  Every  effort  should  be  made  to 
regulate  the  bowels  through  the  food.  Coarse  vegetables  and  fruits, 
particularly  figs  and  prunes,  are  helpful.  Bran  bread,  bran  muffins, 
or  a  tablespoonful  of  bran  added  to  the  morning  cereal,  will  usually 
correct  constipation.7  A  glass  of  cold  water  the  first  thing  in  the 
morning  often  helps.  Eegularity  of  habits  is  most  important,  and  a 
definite  daily  hour  for  the  stool  should  be  established. 

Baths. 

A  daily  bath  is  urgent  during  the  nursing  period,  not  only  for 
cleanliness  but  to  assist  the  action  of  the  skin.  The  mother  at  this 
time  perspires  very  freely  and  efforts  should  be  made  to  keep  the 
body  free  from  odors  of  perspiration  and  stale  milk.  For  the  same 
reasons,  frequent  changes  of  linen  are  desirable. 

Sleep. 

Sufficient  sleep  is  most  necessary  for  the  nursing  mother.  As  soon 
as  possible  the  baby  should  be  given  only  one  nursing  between  6  p.  m. 
and  6  a.  m.,  so  that  the  mother  may  have  a  long,  unbroken  sleep.  At 
least  eight  hours'  sleep  at  night  and  one  hour's  rest  during  the  day 
are  desirable  for  every  nursing  mother.  A  tired  mother  can  not  pro- 
duce the  proper  food  for  her  baby. 

If  the  baby  is  not  trained  to  sleep  at  night,  or  if  he  is  fretful,  it  is 
better  for  some  one  else  to  sleep  in  the  same  room  with  him  or  to  get 
up  with  him  at  night,  in  order  to  save  the  mother's  strength.  Even 
when  the  mother  must  take  charge  of  the  baby  at  night,  the  baby 
must  always  sleep  in  a  bed  by  himself,  and  it  is  better,  after  the  early 
weeks,  for  him  to  sleep  in  the  next  room. 

7  See  recipe  for  bran  muffins,  p.  101. 
44527°— 21 4 


50  INFANT   CARE. 

Work. 

The  mother  should  not  overwork  during  the  nursing  period.  Often 
mothers  who  have  plenty  of  milk  for  their  babies  at  first  find  that 
the  amount  of  their  milk  is  greatly  reduced  when  they  go  back  to 
their  household  duties.  Many  mothers  must  work  hard  during  the 
nursing  period,  but  work  should  be  resumed  gradually.  Most  moth- 
ers are  not  strong  enough  to  undertake  their  regular  duties  until  at 
least  six  weeks  after  childbirth.  By  this  time  the  milk  flow  is  estab- 
lished. 

Fatigue  from  overwork  should  be  avoided  by  short  rests  between 
tasks.  Oftentimes  lying  down  for  five  minutes  every  hour  will  en- 
able the  mother  to  accomplish  much  more  work  than  she  would  other- 
wise be  able  to  do  safely.  To  secure  more  rest  it  is  well  for  the 
mother  to  nurse  her  baby  in  a  semireclining  or  other  comfortable 
position.  This  will  give  the  mother  15  or  20  minutes'  complete  relax- 
ation every  few  hours.  Neither  the  mother  nor  the  baby  should  be 
allowed  to  fall  asleep  before  the  nursing  is  finished. 

Fresh  air  and  exercise. 

Moderate  exercise  in  the  open  air  and  sunshine,  especially  walk- 
ing, is  necessary  to  good  health  and  quiet  nerves  in  a  nursing 
mother.  If  a  mother  has  a  great  deal  of  work  inside  the  house,  she 
will  not  have  the  strength  for  much  walking  or  other  exercise  out- 
doors, but  she  should  make  it  a  practice  to  spend  some  part  of  every- 
day outdoors.  Mothers  who  enjoy  a  vigorous  walk  will  find  this 
good  exercise  for  this  period,  if  not  carried  to  the  point  of  weariness. 
Gardening  is  usually  agreeable  if  not  overdone. 

Fresh  air  indoors  is  needed  both  by  mother  and  baby  for  good 
health,  and  sleeping  and  living  rooms  should  be  kept  well  aired. 

Recreation. 

Some  form  of  recreation,  amusement,  or  pleasure  is  good  for  every- 
one. The  over-conscientious  mother  who  stays  at  home  watching  her 
baby  all  the  time  does  not  do  the  best  thing  for  her  child.  Outdoor 
life  and  pleasant  recreation  which  are  not  exhausting  but  which  keep 
the  mother  happy  and  contented  are  very  beneficial.  Worry,  anger,  or 
strong  emotion  should  be  avoided,  as  they  may  affect  the  milk.  The 
mother  must  learn  to  control  herself  and  to  regulate  her  life  for  the 
best  interests  of  her  baby. 

CARE  OF  THE  BREASTS. 

If  the  mother  has  the  right  care  during  pregnancy  and  the  breasts 
and  nipples  have  received  proper  attention,  the  nursing  period  will  be 
shorn  of  much  possible  discomfort.8     The  object  in  the  care  of  the 

8  See  Prenatal  Care,  p.  14. 


INFANT   CARE.  51 

nipples  during  pregnancy  is  to  draw  them  out  so  as  to  be  easily 
grasped  by  the  baby.  During  the  nursing  period  the  nipples  must  be 
kept  as  clean  and  as  soft  and  flexible  as  possible  to  prevent  cracking. 

The  nipple  and  the  adjacent  part  of  the  breast  should  always  be 
washed  off  before  and  after  each  nursing  with  clean  boiled  water,  and 
dried.  Between  nursings  the  nipple  should  be  covered  with  a  clean, 
freshly  ironed  cloth,  a  piece  of  sterile  gauze,  or  sterile  cotton. 

In  some  cases,  when  the  milk  first  comes  in,  the  breasts  may  become 
engorged  and  painful.  Usually  this  rights  itself  without  difficulty 
as  soon  as  the  relation  between  the  supply  and  the  demand  is  estab- 
lished. During  this  period  of  adjustment,  beside  limiting  the  fluids 
taken,  the  discomfort  from  engorgement  may  be  relieved  by  lifting 
the  breasts  and  keeping  them  partially  under  pressure  by  the  use  of 
a  supporting  breast  binder.  Eegularity  in  nursing  the  baby  is  abso- 
lutely essential. 

The  breast  binder  is  made  from  a  straight  piece  of  strong  muslin, 
long  enough  to  go  around  the  patient  and  wide  enough  to  reach  from 
the  armpits  to  the  waist  line.  The  patient  should  lie  on  her  back  to 
have  the  binder  put  on.  The  binder  should  be  placed  around  the  body 
with  the  ends  in  front.  The  breasts  should  be  drawn  upward,  the 
cotton  placed  on  the  outside  of  the  breasts,  the  ends  of  the  binder 
lapped,  and  the  binder  pinned  snugly  down  the  front  with  safety 
pins.  The  fullness  of  the  binder  below  the  breasts  should  be  taken  up 
by  making  darts  on  both  sides  with  safety  pins.  Shoulder  straps  are 
made  by  putting  a  strip  of  muslin  over  each  shoulder  and  pinning 
the  strips  to  the  binder  in  front  and  behind. 

If  a  binder  is  used  in  time  and  the  mother  takes  little  fluid  in  her 
diet  for  a  few  days  it  is  rarely  necessary  to  empty  the  breast  by  ex- 
pression 9  or  with  a  breast  pump.  Both  of  these  methods  tend  to  in- 
crease the  production  of  milk,  which  is  just  what  is  not  desired.  If 
left  alone,  mild  cases  of  caked  breast  will  disappear  without  treat- 
ment*   Unnecessary  handling  of  the  breasts  should  be  avoided. 

During  the  weaning  period  the  supply  of  breast  milk  should  grad- 
ually disappear  as  the  demand  is  lessened.  Should  the  breasts  be- 
come engorged  and  painful,  the  fluids  should  be  limited  and  the 
binder  described  in  the  above  paragraph  snugly  applied  to  exert  firm 
pressure  on  the  breasts. 

The  first  efforts  of  the  baby  in  nursing  often  make  the  nipples 
sore.  Great  care  must  be  taken  to  keep  the  nipples  free  from  infec- 
tion, or  the  tiny  cracks  of  a  sore  nipple  may  develop  into  a  fissure, 
resulting  sometimes  in  a  breast  abscess.  It  is  wise  never  to  allow  the 
baby's  mouth  to  come  in  direct  contact  with  a  sore  nipple.  Most 
babies  can  draw  the  milk  from  the  breast  through  a  shield.     When 

9  See  section  on  expression  of  breast  milk,  p.  61. 


52  INFANT   CARE. 

the  child  either  will  not  or  can  not  use  the  shield,  the  milk  should 
be  expressed  from  the  breast  and  fed  to  the  child  from  a  nursing 
bottle.  The  supply  of  milk  can  be  maintained  if  the  breasts  are 
emptied  completely  and  at  regular  intervals.  The  nipple  shield 
should  be  cleaned  thoroughly  after  nursing  and  boiled  before  using 
again.  A  cracked  nipple  may  be  treated  by  touching  the  crack  with 
compound  tincture  of  benzoin  and  keeping  it  covered  with  boracic 
acid  ointment.  A  physician  should  be  consulted  for  sore  nipples 
or  caked  breasts. 

TECHNIQUE  OF  NURSING. 

During  the  first  two  weeks  after  birth  the  mother  necessarily 
nurses  her  baby  while  lying  down.  While  nursing  in  this  position 
the  mother  should  place  the  infant  on  the  bed  at  her  side.  The  baby 
must  always  be  able  to  breathe  freely  while  nursing,  so  the  mother 
should  keep  the  breast  from  covering  his  nostrils. 

After  the  mother  is  about,  the  position  for  nursing  should  be  as 
comfortable  as  possible,  so  that  she  may  relax  during  the  nursing 
period. 

The  mother  must  not  be  disturbed  while  nursing,  and  the  baby 
should  not  be  encouraged  to  play  or  be  allowed  to  sleep  while  at  the 
breast.  The  average  time  of  nursing  should  be  between  10  and  20 
minutes.  Occasionally  a  vigorous  child  may  take  enough  in  five 
minutes,  or  a  feeble  baby  may  nurse  so  slowly  that  it  may  take  him 
25  minutes  or  more  to  obtain  a  meal.  If  the  milk  is  plentiful,  only 
one  breast  should  be  nursed  at  a  feeding,  so  that  it  may  be  com- 
pletely emptied.  This  helps  to  produce  milk.  As  the  time  for  wean- 
ing approaches,  or  whenever  the  milk  supply  is  scanty,  it  is  often 
necessary  to  give  both  breasts  at  each  feeding  in  order  to  satisfy  the 
baby,  but  the  breasts  should  always  be  emptied  completely. 

For  the  first  12  to  18  hours  after  delivery  the  mother  should  not 
be  disturbed  nor  her  rest  broken  by  any  attempt  to  nurse  the  baby. 
After  this  the  baby  should  be  put  to  the  breast  at  regular  intervals  not 
oftener  than  every  four  hours  during  the  day.  By  the  third  or  fourth 
day  there  is  usually  plenty  of  breast  milk  for  the  baby.  From  this 
time  on  the  baby  should  be  nursed  at  regular  three-hour  or  regular 
four-hour  intervals  and  should  be  wakened  to  be  fed  at  these  times 
during  the  day.  At  night  the  mother  may  either  let  the  baby  sleep 
until  he  wakens  for  food,  or,  if  this  comes  at  an  hour  uncomfortable 
for  her,  she  may  wake  him  regularly  for  the  night  feedings  also.  As 
early  as  possible  he  should  be  allowed  to  go  with  only  one  feeding 
between  6  p.  m.  and  6  a.  m. 

It  is  important  to  teach  the  baby  during  the  first  days  to  take 
water,  and  he  should  be  offered  an  ounce  of  boiled  water  two  or  three 


INFANT    CARE.  53 

times  a  day.    It  is  better  for  the  child  not  to  have  sugar  added  to 
this  water. 

Teaching  the  child  to  take  food  at  regular  hours  and  to  be  satis- 
fied when  fed  only  at  these  periods  is  the  first  important  lesson  the 
mother  can  impart.  A  baby  is  born  with  no  habits.  It  rests  with  the 
mother  whether  the  habits  he  acquires  are  good  or  bad.  This  early 
habit  of  "  taking  food  by  the  clock  "  is  most  important,  because  the 
health  of  the  baby  and  the  comfort  of  the  mother  depend  so  largely 
upon  it.  From  the  beginning  the  mother  or  nurse  must  insist  on  the 
baby's  waiting  until  the  hour  for  nursing  arrives.  If  this  is  persisted 
in,  the  average  baby  is  trained  by  the  second  month  to  wake  regularly 
for  food  and  to  sleep  quietly  most  of  the  time  between  nursings. 

FEEDING  RULES. 
Feeding  intervals. 

During  second  day,  4-hour  intervals — 5  feedings  in  24  hours  (6 
a.  m.,  10  a.  m.,  2  p.  m.,  6  p.  m.,  10  p.  m.). 

Third  day  to  third  month,  3-  or  4-hour  intervals — 6  or  7  feedings  in 
24  hours  (6  a.  m.,  9  a.  m.,  12  m.,  3  p.  m.,  6  p.  m.,  10  p.  m.,  and  2  a.  m., 
if  necessary) ,  or  5  or  6  feedings  on  a  4-hour  schedule  (6  a.  m.,  10  a.  m., 
2  p.  m.,  6  p.  m.,  10  p.  m.,  and  2  a.  m.,  if  necesary).  Unless  the  baby's 
gain  can  be  accurately  determined  by  regular  weighing,  it  is  safer  to 
nurse  the  baby  on  a  3-hour  schedule  during  the  first  two  or  three 
months  of  life. 

Third  month  to  sixth  month,  3-  or  4-hour  intervals — 6  feedings  in 
24  hours  (6  a.  m.,  9  a.  m.,  12  m.,  3  p.  m.,  6  p.  m.,  and  10  p.  m.),  or  5 
feedings  on  a  4-hour  schedule  (6  a.  m.,  10  a.  m.,  2  p.  m.,  6  p.  m.,  and 
10  p.m.). 

During  and  after  sixth  month,  4-hour  intervals — 5  feedings  in  24 
hours  (6  a.  m.,  10  a.  m.,  2  p.  m.,  6  p.  m.,  and  10  p.  m.). 

Amount  of  food. 

The  amount  of  food  a  normal  breast-fed  infant  takes  in  the  24 
hours  varies  with  the  individual  baby  as  well  as  with  his  age  and 
size.  During  the  first  week  the  baby  may  take  from  10  to  16  ounces 
a  day ;  after  that  from  2  to  3  ounces  a  day  for  every  pound  of  weight. 

The  amount  which  the  baby  takes  at  each  nursing  varies,  but  it 
depends  largely  on  the  demands  of  the  child.  The  infant  on  a  four- 
hour  schedule  usually  takes  more  at  a  nursing  than  when  on  a  three- 
hour  interval,  but  he  gets  no  more  food  in  the  24  hours,  as  he  has  one 
less  feeding. 

GROWTH. 

The  weight  at  birth  averages  about  7  pounds.  For  the  first  few 
days  the  mother's  milk  is  not  sufficient  for  the  baby  to  maintain  his 


54  INFANT  CARE. 

weight  or  to  allow  for  growth.  Therefore,  most  babies  lose  about 
one- tenth  of  the  birth  weight  during  the  first  days  of  life.  In  some 
cases,  until  the  milk  supply  is  properly  established,  the  deficiency  in 
food  may  have  to  be  in  part  supplied  by  giving,  after  the  breast  feed- 
ings, 1  to  2  ounces  of  a  5  per  cent  sugar  of  milk  solution,10  but  this 
is  not  usually  necessary. 

The  sugar  solution  should  be  omitted  after  the  first  few  days  or  as 
soon  as  the  breast  milk  is  established. 

The  giving  of  this  sugar  solution  is  not  to  take  the  place  of  boiled 
water,  which  should  be  offered  between  feedings  several  times  a  day 
throughout  infancy. 

There  is  only  one  reliable  indication  of  whether  or  not  a  baby  has 
sufficient  food  and  only  one  sure  way  to  tell  how  much  he  is  taking  at 
a  meal.  The  scales  will  settle  both  these  points.  A  normal  breast-fed 
child  gains  from  4  to  8  ounces  a  week  the  first  six  months  of  life,  and 
after  this  from  4  to  6  ounces.  A  simple  rule  is  that  a  baby  doubles 
its  birth  weight  at  the  end  of  the  fifth  month  and  trebles  it  by  the  end 
of  the  first  year.  The  average  weekly  gain  during  the  first  five 
months  should  be  about  5  ounces;  during  the  remainder  of  the  year, 
4  ounces.  The  weighing  of  a  baby  once  or  twice  a  week  will  definitely 
settle  whether  or  not  he  is  gaining  satisfactorily. 

No  two  infants  are  exactly  alike  in  their  development,  or  in  their 
power  to  make  use  of  food,  but  it  is  a  fairly  good  indication  that  a 
well  infant  is  not  having  the  proper  kind  or  the  right  amount  of  food 
if  he  fails  to  make  any  gain  for  a  two-weeks  period,  or  makes  un- 
satisfactory gains  over  a  longer  period.  To  find  out  the  amount  of 
milk  a  baby  gets  at  a  feeding,  he  should  be  weighed  in  the  same 
clothes  just  before  and  just  after  each  feeding;  the  increase  in 
weight  gives  the  ounces  of  food  taken.  It  must  be  remembered  that 
the  amounts  taken  at  different  feedings  vary.  Therefore,  conclusions 
must  not  be  drawn  from  weighing  the  baby  before  and  after  a  single 
nursing,  but  he  should  be  weighed  before  and  after  each  feeding  for 
one  or  two  days  until  it  can  be  settled  how  much  he  averages  at  a 
feeding. 

CONDITIONS  INFLUENCING  THE  BREAST  MILK. 

There  are  periods  when  the  breast  milk  may  normally  not  be 
sufficient.  One  is  at  the  beginning  of  nursing,  before  the  supply  is 
established,  when  the  mother  first  gets  up  and  resumes  her  household 
duties ;  another,  near  the  end  of  the  nursing  period,  when  the  supply 
begins  to  diminish.  In  any  case  the  baby  should  not  be  weaned 
suddenly,  but  the  mother's  diet  and  welfare  should  be  watched  care- 
fully and  artificial  food  should  be  given  in  addition,  if  necessary. 

10  Two  level  tablespoonfuls  milk  sugar  to  one  pint  of  boiled  water. 


INFANT    CARE.  55 

Part  breast  and  part  bottle  feeding  may  be  combined  at  every  feeding 
for  many  months,  the  former  always  being  given  first. 

Illness. 

Nursing  mothers  should  be  warned  against  removing  the  baby 
from  the  breast  merely  because  the  mother  has  a  slight  disorder  or 
sickness.  During  most  cases  of  brief  illness  of  the  mother,  the  infant 
may  be  safely  nursed. 

A  sudden,  severe  illness  of  the  mother,  especially  an  acute  infectious 
disease  with  fever,  may  make  it  necessary  to  remove  the  baby  from 
the  breast  temporarily.  This  may  mean  for  only  a  few  feedings, 
but  if  the  mother's  illness  is  longer  and  more  serious,  the  baby  may 
be  deprived  of  the  breast  for  a  week  or  two.  In  any  case  it  is  wise 
to  make  every  effort  to  keep  up  the  supply  of  breast  milk  by  empty- 
ing the  breasts  completely  at  regular  intervals,  and  the  baby  should 
return  to  breast  feeding  at  the  first  possible  moment. 

While  the  mother  is  acutely  ill,  if  it  is  necessary  to  put  the  baby 
on  artificial  feeding  it  should  be  done  only  under  a  doctor's  advice. 

Menstruation. 

The  return  of  menstruation  is  often  wrongly  considered  a  cause 
for  weaning.  Nearly  half  of  all  nursing  mothers  begin  to  menstruate 
again  as  early  as  the  third  month  after  childbirth.  The  average 
well  baby  shows  no  discomfort  during  this  period,  although  he  may 
not  gain  in  weight  for  a  few  days.  In  a  very  few  cases  the  baby  may 
seem  irritable,  sleep  fretfully,  and  have  undigested  stools.  Usually 
if  the  baby  is  affected  at  all  it  is  during  the  few  days  before  men- 
struation rather  than  during  the  period  of  the  flow.  The  baby  should 
not  be  removed  from  the  breast  during  menstruation,  although  it 
may  be  well  to  give  him  artificial  feeding  in  addition,  if  the  period 
of  breast  feeding  is  nearly  over. 

Pregnancy. 

If  the  mother  becomes  pregnant  she  should  wean  the  baby.  It  is 
too  great  a  strain  on  the  mother  to  nourish  two  lives  beside  her  own, 
and  the  breast  milk  is  likely  to  become  too  poor  and  scanty  to  nour- 
ish the  baby  properly. 

DIFFICULTIES  OF  THE  NURSING  PERIOD. 

During  the  early  period  of  nursing  there  may  be  minor  digestive 
disturbances  in  the  baby  which  may  cause  mothers  some  anxiety. 
It  is  usually  only  a  matter  of  adjustment  of  the  baby's  digestive  tract 
to  a  new  function  and  should  never  be  considered  an  excuse  for  wean- 
ing from  the  breast. 


56  INFANT   CARE. 

Stools. 

The  first  passages  from  a  newborn  baby's  bowels  are  known  as 
meconium.  The  excretion  is  very  dark  green,  thick  and  sticky,  with 
little  or  no  odor.  This  soon  changes  to  the  normal  yellow  stool  of 
the  healthy  infant  as  the  baby  begins  to  feed  at  his  mother's  breast. 

Ordinarily  a  breast-fed  child  should  have  one  to  four  stools  a  day, 
bright  orange-yellow  in  color  (though  occasionally  greenish),  soft 
and  mealy,  often  rather  loose  in  character. 

Occasionally  a  breast-fed  baby,  who  is  apparently  perfectly  well, 
with  a  normal  temperature,  comfortable  and  thriving,  continues  to 
have  loose  greenish  stools  containing  small  curds  or  some  mucus, 
in  spite  of  the  best  attention  which  can  be  given  to  the  mother. 
Such  stools  in  an  artificially-fed  baby  would  be  a  reason  for  chang- 
ing the  food,  but  in  a  nursing  baby  who  is  well  and  gaining  they  may 
be  largely  disregarded. 

More  rarely  the  breast-fed  baby  may  be  constipated,  particularly 
if  the  mother  showrs  this  tendency.  In  such  cases  the  mother  should 
correct  her  own  condition.11  Plenty  of  water  should  be  given  to  the 
baby  between  feedings,  and  as  early  as  the  third  month  orange  juice 
may  be  added  to  the  diet. 

Underfeeding. 

It  happens  sometimes  that  a  breast-fed  baby  is  underfed.  Such  an 
infant  shows  no  gain  in  weight  or  more  often  shows  a  loss  in  weight. 
The  baby  either  nurses  for  a  brief  interval  and  then  gives  up  and 
falls  asleep  or  shows  great  distress  after  an  exhausting  attempt  to 
obtain  food.  The  stools  are  scanty,  often  only  brown  stains.  The 
child  seems  weak  and  may  feel  flabby  and  look  pale,  but  he  usually 
cries  very  little  and  sleeps  a  great  deal. 

The  fact  that  a  baby  does  not  gain  in  weight  or  actually  loses  in 
weight  immediately  suggests  that  he  is  not  getting  enough  food. 
Weighing  the  baby  for  several  days  before  and  after  each  feeding 
will  prove  this.  If  the  baby  is  not  getting  enough  food,  artificial 
food  must  be  temporarily  supplied  as  a  part  of  the  diet. 

It  may  be  that  the  mother  has  not  enough  milk  or  it  may  be  that 
the  baby  is  not  vigorous  enough  to  nurse  properly  or  has  a  deformed 
mouth. 

If  the  trouble  is  due  to  real  lack  of  milk  supply  more  attention 
should  be  paid  to  the  hygiene  of  the  mother.  She  must  have  plenty 
of  rest  and  sleep  and  she  must  take  the  proper  amount  of  food  and 
liquid.  Under  any  circumstances  it  is  most  important  that  the 
breasts  be  emptied  thoroughly  at  regular  intervals  in  order  to  stimu- 
late the  production.     Weak  babies  or  those  with  deformed  mouths 

11  See  Breast  Feeding,  p.  49  ;  also  U.  S.  Children's  Bureau  Dodger  No.  4,  Washington, 
1921. 


INFANT   CARE. 


57 


should  be  fed  the  milk  which  has  been  expressed.12  Persistent  efforts 
to  increase  the  amount  of  milk  will  usually  be  successful. 

If  after  such  methods  the  mother's  milk  still  is  insufficient,  mixed 
feeding — part  breast  feeding  and  part  bottle  feeding — may  be  given 
for  weeks  or  even  months.  One  bottle  feeding  a  day  should  be  given 
in  place  of  the  breast,  or  the  bottle  should  be  given  after  each  breast 
feeding  to  make  up  the  necessary  amount. 

By  giving  part  breast  milk  and  part  cow's  milk  a  well  baby  will 
usually  have  no  difficulty  in  digesting  the  cow's  milk.  Even  a  little 
breast  milk  may  prevent  digestive  disorders.  In  case  the  baby  is 
disturbed  or  sick  the  bottle  can  be  stopped  for  a  few  days  and  only 
the  breast  given  and  boiled  water  may  be  given  in  place  of  the  cow's 
milk. 

Overfeeding. 

Overfeeding  is  rare  in  the  breast-fed  baby.  When  it  occurs  it 
usually  means  that  the  nursing  periods  are  too  frequent  or  that  the 
quantity  taken  at  one  time  is  too  large,  or  that  the  milk  is  too  rich  in 
fat.  Under  such  circumstances  the  baby  usually  spits  up  after 
nursing  and  is  fussy. 

To  remedy  this,  the  time  at  the  breast  should  be  decreased  and  the 
interval  between  feedings  increased  to  four  hours.  A  few  spoonfuls 
of  warm  water  just  before  nursing  will  dilute  the  milk. 

SUMMARY  OF  FEEDING  FOR  A  WELL  BREAST-FED  BABY. 

FEEDING  THE   FIRST  SIX  MONTHS. 


Early  morning  nursing 

Fruit  juice  (after  3  months) — 1  teaspoonful  to  1  ounce  of 

the  juice  diluted  in  1  to  3  ounces  of  boiled  water 

Mid-morning  nursing 

Mid-day  nursing 

Water  boiled  and  cooled,  offer  1  to  3  ounces 

Mid -afternoon  n  ursing 

Water  boiled  and  cooled,  offer  1  to  3  ounces 

Bed-time  nursing 

Night  .nursing 


Three-hour 
feeding  interval 


6.00  a.  m. 

8.30  a.  m. 
9.00  a.  m. 
12.00  m. 


3.00  p.  m. 


6.00  p.  m. 
«10.00  p.  m. 


Four-hour 
feeding  interval. 


6.00  a.  m. 

9.30  a.  m. 

10.00  a.  m. 

2. CO  t>.  m. 


None. 


6.00  p.  m. 
« 10.00  p.  m. 


a  Or  later.    During  the  early  weeks  of  life  a.second  night  nursing  between  10  p.  m.  and  6  a.  m.  may  be 
needed,  but  as  soon  as  possible  the  baby  should  sleep  unbrokenly  after  one  night  feeding. 


12  See  section  on  expression  of  breast  milk,  p.  61. 


58 


INFANT  CARE. 

FEEDING  6  MONTHS   TO   1  YEAR. 


Four-hour 
interval. 

6.00  a. 
9.30  a. 

in 
n? 

10.00  a. 

2.00  p. 

5.00  p. 

6.00  p. 
10.00  p. 

m 
m 
m 
m 

m 

2.00  p. 

in 

2.00  p. 

ni. 

Sixth  month: 

Nursing 

Fruit  juice,  1  to  2  ounces,  diluted  with  1  to  4  ounces  of  boiled  water 

Well-cooked  cereal,  1  to  2  rounded  tablespoonfuls,  followed  by 
nursing 

Nursing 

Water,  1  to  6  ounces,  boiled  and  cooled 

Half  slice  zwieback  or  crisp  toast,  followed  by  the  nursing 

Nursing 

Seventh  month: 

By  the  seventh  month,  strained  vegetable  soup,  1  to  6  ounces,  may 

be  given,  followed  by  nursing 

Ninth  month: 

By  the  ninth  month,  1  to  3  teaspoonfuls  of  vegetable  pulp  may  be 
added  to  the  strained  soup 


Note. — One  bottle  feeding  may  be  substituted  in  place  of  one  nursing. 

Usually  after  nine  months,  and  before  if  necessary,  weaning  should 
be  begun.  (See  below.)  Every  child  should  be  entirely  weaned 
before  he  is  a  year  old. 

For  strength  and  amount  of  milk  mixture  used  in  feedings  to  be 
given  during  these  months  see  "  Summary  of  Artificial  Feeding  to 
1  Year,"  page  74. 

WEANING. 

The  first  months  in  the  life  and  development  of  a  child  are  the 
most  critical  period.  Weaning  at  this  time  is  a  serious  matter.  A 
well  baby  after  he  is  6  months  old  can,  as  a  rule,  be  successfully 
weaned  when  necessary,  if  it  is  properly  done.  However,  at  least 
part  breast  feeding  should  be  continued  throughout  the  next  three 
months  or  even  longer,  if  possible,  depending  upon  the  infant's 
health,  the  season,  and  the  other  circumstances. 

Sometimes  a  baby  can  not  take  cow's  milk,  but  this  is  very  un- 
usual. In  such  a  case  milk  from  a  goat  or  some  other  domestic  animal 
may  be  tried. 

As  a  rule  the  trouble  in  weaning  is  not  because  the  infant  can  not 
digest  cow's  milk,  but  because  the  change  is  made  too  suddenly,  or  the 
food  given  at  first  is  not  properly  adapted  to  the  infant.  (For 
formula  that  may  be  given  to  the  baby  according  to  age,  see  p.  74.) 

How  to  wean. 

If  the  baby  is  already  having  some  artificial  food,  weaning  need 
not  take  more  than  two  weeks.  One  entire  bottle  feeding  may  be 
given  in  place  of  a  breast  feeding.  After  several  days,  if  the  baby 
is  not  upset,  another  bottle  may  be  given.  A  part  bottle  feeding  may 
have  to  be  given  at  the  end  of  the  other  breast  feedings.    By  gradu- 


INFANT   CARE.  59 

ally  changing  in  this  way  from  breast  feeding  to  bottle  feeding,  wean- 
ing can  usually  be  completed  in  two  weeks  without  upsetting  the 
baby.  It  is  very  seldom  necessary  to  wean  in  a  shorter  time  than 
this  and  there  is  every  reason  to  wean  gradually  so  as  to  prevent  any 
disturbance. 

Sometimes  a  perfectly  normal  baby  over  6  months  of  age  will  re- 
fuse to  use  a  bottle  when  the  mother  tries  to  wean  him.  As  a  baby 
less  than  1  year  of  age  seldom  gets  enough  food  when  fed  from  a 
cup  or  spoon  the  mother  should  keep  on  trying  to  make  the  infant 
draw  from  the  bottle.  Persistent  effort  will  usually  be  successful. 
In  case  the  child  refuses  both  the  bottle  and  the  cup  and  weaning  has 
to  be  carried  out,  food  should  be  offered  only  at  regular  four-hour 
intervals.  The  child  will  finally  yield  and  take  artificial  food.  If 
he  has  been  accustomed  to  taking  water  from  a  bottle,  there  is  much 
less  difficulty  in  weaning. 

Weaning  in  hot  weather  even  for  a  well  baby  must  be  done  grad- 
ually and  undertaken  with  great  care.13 

WET  NURSES. 

In  some  cases  if  the  mother  can  not  nurse  the  baby  it  is  necessary 
to  engage  the  services  of  a  wet  nurse.  Some  new-born  babies, 
especially  those  prematurely  born,  and  some  very  delicate  babies, 
or  those  suffering  from  chronic  digestive  disturbance,  can  not  be 
made  to  thrive  on  artificial  food.  For  such  babies  it  is  wise  to 
provide  a  wet  nurse.  In  large  cities  there  are  agencies  where  wet 
nurses  can  be  obtained.  In  small  towns  or  in  the  country  wet  nurses 
can  be  secured  by  advertising,  or  by  inquiry  at  a  maternity  hospital 
in  some  near-by  city.  Frequently  breast  milk  may  be  obtained  by 
expression  from  another  mother  and  not  infrequently  a  friend  will 
nurse  another  baby  than  her  own  (see  p.  52,  Technique  of  nursing). 

When  a  wet  nurse  is  secured  it  is  not  necessary  that  her  baby 
should  be  the  same  age  as  the  baby  to  be  nursed.  It  is  best  to  en- 
gage a  nurse  whose  baby  is  old  enough  and  whose  condition  is  such  as 
to  indicate  that  she  can  produce  an  abundant  milk  supply.  Also,  the 
wet  nurse  should  not  be  too  near  the  weaning  period. 

Every  wet  nurse  should  nurse  her  own  baby.  Her  peace  of  mind 
will  insure  better  breast  milk.  Also,  if  the  baby  to  be  wet-nursed 
is  small  and  weak  it  may  be  an  advantage  to  have  the  wet  nurse's 
breasts  emptied  afterwards  by  a  more  vigorous  child.  Professional 
wet  nurses  in  hospitals  often  furnish  enough  milk  for  several  babies 
at  a  time,  so  there  need  be  no  fear  that  a  wet  nurse  can  not  supply 
milk  for  two  if  she  has  good  breasts,  if  her  life  is  properly  regulated 
and  her  diet  ample. 

13  See  section  on  hot  weather  disturbances,  p.  85. 


60  INFANT  CAKE. 

The  general  appearance  of  the  wet  nurse  and  her  child  should  be 
considered  before  she  is  engaged.  The  healthy  appearance  of  her 
child  is  a  guaranty  of  her  ability  to  nurse.  Also  it  is  absolutely 
necessary  that  the  .nurse  herself  be  given  a  complete  physical  exam- 
ination by  a  physician.  She  must  be  perfectly  healthy  and  must  not 
have  any  disease  which  she  could  transmit  to  her  nursling.  Acute 
tuberculosis,  gonorrhea,  and  syphilis  are  the  diseases  most  to  be  looked 
for.  The  complete  physical  examination  which  should  be  given 
her  by  a  physician  before  she  is  engaged  should  include  the  blood 
test  for  syphilis  and  examination  for  gonorrhea,  whether  or  not  she 
shows  any  symptoms  of  these  diseases. 

Often  much  tact  is  necessary  in  managing  a  wet  nurse.  It  is  a 
mistake,  however,  to  pamper  her  with  luxuries.  She  should  do  the 
amount  of  work  she  is  used  to  doing  in  her  own  home,  and  she  should 
be  given  a  simple  and  nutritious  diet  and  should  have  the  respon- 
sibility and  care  of  her  own  baby. 

THE  SMALL  OR  DELICATE  INFANT. 

The  premature  baby. 

The  methods  of  feeding  and  care  of  the  infant  born  before  full 
term  are  applicable  also  to  a  small  delicate  baby. 

The  normal  body  temperature  must  be  maintained.  Infants  may 
die  from  exposure  because  of  lack  of  proper  care  immediately  after 
birth.  Any  infant  weighing  5  pounds  or  less  at  birth  should  be 
immediately  protected  from  excessive  loss  of  heat,  because  the  heat- 
producing  power  at  this  time  is  so  feeble.  Such  a  baby  should  be 
handled  as  little  as  possible  and  therefore  oiled,  not  washed,  and 
rolled  in  flannel  or  cotton  temporarily  so  that  the  entire  body  ex- 
cept the  face  is  covered.  For  permanent  use  a  simple  cheesecloth 
jacket  padded  with  cotton  should  be  made,  and,  to  avoid  handling, 
no  other  clothes  are  necessary.  A  pad  of  cheesecloth  and  cotton 
may  be  used  instead  of  a  diaper.  The  baby  should  then  be  wrapped 
in  a  knitted  shawl  or  small  wool  blanket  and  placed  in  a  large  flat- 
bottomed  basket  or  box,  which  has  been  padded  and  lined  with  a 
blanket,  and  partially  covered  with  another  blanket.  Extra  heat 
should  be  carefully  maintained  by  means  of  hot-water  bags  or  bottles 
placed  around  the  baby.  Great  care  should  be  used  not  to  burn 
the  baby. 

The  room  in  which  the  infant  is  kept  should  be  well  ventilated, 
but  a  constant  temperature  of  75°  to  80°  F.  should  be  maintained. 
The  temperature  of  the  crib  should  be  between  80°  and  90°  F. 

Premature  babies  are  particularly  prone  to  infection,  especially 
colds,  which  may  prove  fatal.  All  visitors  must  be  excluded  from 
the  room. 


INFANT   CARE.  61 

The  infant  should  be  fed  while  in  the  basket  and  removed  only 
every  other  day  for  an  oil  rub  and  clean  clothing.  His  position  in  the 
crib  should  be  changed  frequently. 

The  premature  infant  is  usually  far  too  weak  to  nurse  or  to  draw 
from  a  bottle,  so  that  the  milk  has  to  be  expressed  and  fed  slowly  by 
means  of  a  medicine  dropper  or  stomach  tube.  If  a  medicine  dropper 
is  used  the  end  should  be  protected  by  slipping  over  it  a  small  piece 
of  rubber  tubing.  As  it  may  be  some  weeks  before  the  baby  is  able 
to  nurse  even  small  amounts,  it  will  be  necessary  for  the  mother  to 
empty  her  breasts  at  regular  intervals.  This  can  be  done  by  ex- 
pression. The  premature  infant  should  be  fed  breast  milk  begin- 
ning with  a  teaspoonful  every  two  hours.  Gradually  increase  the 
quantity  given  at  each  feeding  as  rapidly  as  possible  -until  the  baby 
is  getting  in  24  hours  3  ounces  for  each  pound  of  body  weight.  The 
intervals  between  feeding  should  then  be  lengthened  to  three  hours. 
Some  premature  infants  do  better  from  the  beginning  on  three-  or 
four-hour  feeding  intervals.  Under  such  circumstances,  in  order 
that  they  may  obtain  sufficient  food,  it  is  sometimes  necessary  that 
the  feeding  be  done  by  means  of  a  catheter  improvised  as  a  stomach 
tube  and  used  by  a  trained  person. 

It  is  particularly  important  that  premature  infants  be  given  water 
between  feedings.  The  total  quantity  of  milk  and  water  given  in  24 
hours  should  not  at  any  time  be  less  than  3  ounces  per  pound  of 
body  weight,  and  it  is  therefore  necessary  to  give  a  larger  quantity  of 
water  at  first  when  the  baby  is  getting  a  small  amount  of  milk. 

The  stronger  and  more  vigorous  infants  may  be  put  to  the  breast 
like  normal  infants.  Care  should  be  taken  to  be  sure  that  they  are 
not  fatigued  by  the  process. 

The  feeding  of  a  premature  or  delicate  infant  is  a  most  serious 
problem.  Until  the  mother's  milk  is  established,  every  effort  should 
be  made  to  secure  a  few  ounces  of  milk  from  some  other  woman 
nursing  her  own  child  or  to  obtain  a  regular  wet  nurse.  The  wet 
nurse's  baby  should  accompany  her  and  should  be  used  to  stimulate 
the  breasts  of  the  premature  baby's  mother.  The  age  of  the  wet 
nurse's  baby  is  not  important,  for  the  milk  can  usually  be  adapted  to 
the  digestive  powers  of  the  baby  in  question. 

EXPRESSION  OF  BREAST  MILK. 

Scrub  the  hands  and  nails  with  soap,  warm  water,  and  a  nail  brush 
for  at  least  one  full  minute.  Wash  the  nipple  with  fresh  absorbent 
cotton  and  boiled  water  or  a  freshly  made  boric  solution.  Dry  the 
hands  thoroughly  on  a  clean  towel  and  keep  them  dry.  Have  a 
sterilized  graduate  glass  tumbler  or  large-mouth  bottle  to  receive  the 
milk. 


62  INFANT  CARE. 

1.  Grasp  the  breast  gently  but  firmly  between  the  thumb  placed  in 
front  and  the  remainder  of  the  fingers  on  the  under  surface  of  the 
breast.  The  thumb  in  front  and  the  first  finger  beneath  should  rest 
just  outside  of  the  pigmented  area  of  the  breast. 

2.  With  the  thumb  a  downward  pressing  motion  is  made  on  the 
front  against  the  fingers  on  the  back  of  the  breast,  and  the  thumb 
in  front  and  fingers  behind  are  carried  downward  to  the  base  of  the 
nipple. 

3.  This  second  act  should  end  with  a  slight  forward  pull  with 
gentle  pressure  at  the  back  of  the  nipple  which  causes  the  milk  to 
flow  out. 

The  combination  of  these  three  movements  may  be  described  as 
"  Back-down-out." 

It  is  not  necessary  to  touch  the  nipple. 

This  act  can  be  repeated  30  to  60  times  a  minute  after  some  prac- 
tice. 

Both  breasts  may  be  emptied  if  necessary  or  they  may  be  used 
alternately. 

The  milk  should  be  covered  at  once  by  a  sterile  cloth  held  in  place 
by  a  rubber  band  and  kept  on  ice  until  used. 

ARTIFICIAL  FEEDING. 

There  is  no  perfect  substitute  for  mother's  milk;  therefore,  every 
effort  should  be  made  to  encourage  the  mother  to  nurse  her  baby 
before  attempting  artificial  feeding.  If  artificial  feeding  must  be 
used  the  problem  is  to  adapt  the  milk  of  cows  or  other  animals  so 
that  it  will  be  serviceable  for  infant  feeding. 

SUBSTITUTES  FOR  MOTHER'S  MILK. 

Some  form  of  milk  is  absolutely  necessary  for  the  normal  growth 
and  development  of  all  children  under  2  years  of  age. 

Babies  have  a  marvelous  ability  to  use  a  wide  range  of  food  sub- 
stances. This  is  why  many  strange  foods  and  strange  methods  of 
feeding  are  apparently  successful  for  a  short  time.  Almost  every 
article  of  foodstuff  has  been  fed  to  some  baby,  and  perhaps,  in  a 
single  case,  successfully.  This  does  not  mean  that  the  food  would  be 
safe  for  other  babies. 

The  milk  of  domestic  animals  furnishes  food  which  is  more  nearly 
adequate  for  a  baby  than  any  other  foodstuff. 

Cow's  milk  is  the  milk  commonly  used  in  America.  Goat's  milk 
is  used  in  many,  countries  and  in  some  sections  of  the  United  States 
its  use  is  being  extended.    There  is  a  general  idea  that  it  is  cheaper 


EXPRESSION   OF  BREAST   MILK. 


02 


INFANT    CARE.  63 

to  feed  a  goat  than  a  cow,  but  for  the  amount  of  milk  obtained  that 
is  probably  not  true.  One  advantage  about  goats  is  that  they  very 
seldom  have  tuberculosis.  Goat's  milk  is  similar  in  composition  to 
cow's  milk,  and  the  average  baby  can  take  goat's  milk  as  success- 
fully as  cow's  milk.  The  amount  given  and  the  dilution  should  be 
the  same  as  of  cow's  milk. 

Ass's  milk  is  recommended  by  some  European  physicians  because  it 
contains  very  little  fat  and  is  more  easily  digested  by  young  infants 
on  this  account. 

Different  kinds  of  cow's  milk.14 

There  are  the  following  kinds  of  milk  which  are  suitable  and  avail- 
able for  infant  feeding :  Fresh  raw  milk,  u  pasteurized "  milk, 
scalded  milk,  boiled  milk,  and  milk  which  has  been  condensed,  evapo- 
rated, or  dried. 

Raw  milk. — Milk  that  can  safely  be  used  raw  must  be  fresh,  clean, 
and  free  from  disease  germs.  It  must  be  produced  by  healthy  cows, 
handled  by  healthy  milkers  under  the  cleanest  and  most  sanitary  con- 
ditions. The  milk  must  be  kept  chilled  from  the  time  of  milking 
until  it  reaches  the  consumer.  Milk  of  this  description  is  known  in 
certain  cities  as  Grade  A  raw  milk.  When  milk  is  guaranteed 
to  meet  certain  requirements  of  analysis  and  inspection,  it  is  called 
"  certified  " 15  milk.  Certified  milk  because  of  the  care  in  its  produc- 
tion costs  more  than  other  milk,  and  it  constitutes  a  very  small  pro- 
portion of  milk  sold. 

Unless  milk  is  produced  from  tuberculin-tested  cows  on  the  prem- 
ises with  the  utmost  cleanliness  and  care,  or  unless  certified  milk 
can  be  obtained,  it  is  safer  not  to  use  raw  milk  for  infant  feeding. 

Pasteurized  milk. — To  pasteurize  milk,  it  is  heated  to  a  tempera- 
ture of  145°  F.  and  kept  at  that  temperature  for  30  minutes  and  im- 
mediately chilled  and  kept  below  50°  F.  until  used.  This  process 
destroys  disease  germs.  Pasteurized  milk  should  be  used  within 
24  hours. 

Scalded  milk. — To  scald  milk,  heat  it  in  an  open  vessel  until  it 
bubbles  around  the  edges  and  steams  in  the  center.  This  will  mean  a 
temperature  of  from  167°  to  185°  F.  and  it  will  destroy  all  ordinary 
disease  germs.    Scalding  is  not  boiling. 

Boiled  milk. — To  boil  milk  is  to  heat  it  to  the  boiling  point  (212° 
F.),  and  it  should  be  allowed  to  boil  for  three  minutes. 

14  Mendenholl,  Dorothy  Reed,  M.  D.  :  Milk,  the  Indispensable  Food  for  Children,  p.  IS. 
IT.  S.  Children's  Bureau  Publication  No.  35.  Care  of  Children  Series,  No.  4.  Washing- 
ton, 1918. 

18  "  Certified  "  milk  is  a  name  adopted  by  the  American  Association  of  Medical  Milk 
Commissions  and  is  legally  protected  in  a  number  of  States. 


64  INFANT  CARE. 

For  infant  feeding,  all  milk  should  be  fresh  and  clean.  Unclean 
milk  is  not  fit  for  babies,  even  if  pasteurized  or  scalded.  Commer- 
cial pasteurization,  even  though  properly  done,  does  not  make  milk 
safe  for  infant  feeding  unless  the  milk  is  properly  handled  after 
pasteurization.  If  there  is  any  question  as  to  the  method  of  pasteur- 
izing and  proper  handling,  such  milk  should  be  scalded  before  feed- 
ing it  to  an  infant.  Unscrupulous  dealers  have  been  known  to  adver- 
tise their  milk  as  "  pasteurized  "  or  even  "  certified  "  when  that  was 
not  true.  Bottled  certified  milk  has  "  certified  "  blown  in  the  bottle 
or  stamped  on  the  cap. 

Condensed  and  evaporated  milk. — There  are  two  kinds  of 
canned  milk — sweetened  (condensed)  and  unsweetened  (evaporated). 
Sweetened  condensed  milk  is  not  suitable  for  infants  because  of  the 
large  amount  of  sugar  and  the  small  amount  of  milk  which  it  con- 
tains. If  the  baby  is  given  enough  of  this  milk  for  his  growth  and 
development  he  will  have  too  much  sugar.  If  this  milk  is  diluted  so 
that  the  amount  of  sugar  is  correct,  the  baby  will  not  get  enough  milk. 
Most  infants  fed  only  on  condensed  milk  show  nutritional  disturb- 
ances sooner  or  later.  Evaporated  milk  may  be  used  in  emergen- 
cies for  a  short  time  only. 

Dry  milk  or  milk  powder. — Dry  milk  has  been  used  successfully  in 
infant  feeding  abroad  during  and  since  the  war  and  also  in  this 
country.  There  are  several  kinds  of  milk  powder  on  the  market, 
made  from  whole,  skim,  or  half-skim  milk,  which  can  be  adapted  to 
artificial  feeding. 

It  is  important  that  dried  milk  be  made  from  clean  cow's  milk. 
This  is  a  matter  over  which  the  individual  mother  has  no  control, 
but  after  a  can  has  been  opened,  she  should  make  sure  that  it  is 
tightly  closed  and  kept  where  it  can  not  become  contaminated. 

The  milk  powder  should  be  made  liquid  by  adding  enough  water 
(see  directions  on  the  package)  to  have  the  value  of  whole  milk. 
It  may  then  be  used  as  if  it  were  fresh  milk  and  diluted  according 
to  the  baby's  age.  It  should,  however,  be  used  only  during  such 
time  as  fresh  milk  can  not  be  obtained. 

In  using  canned  or  dried  milk  it  is  very  important  to  give  the  baby 
also  some  vegetable  or  fresh  fruit  juice. 

Proprietary  infant  foods. 

There  are  two  kinds  of  proprietary  or  patent  infant  foods.  The 
first  kind  contains  dry  milk.  The  second  kind  of  patent  food,  com- 
monly called  "  milk  modifiers,"  contains  no  milk  and  must  be  added 
to  fresh  milk.  These  latter  foods  consist  largely  of  sugar  and  starch. 
Mothers  should  understand  clearly  that  this  second  kind  of  prepara- 
tion is  an  incomplete  food  unless  it  is  added  to  milk.  Mothers  have 
sometimes  starved  their  babies  because  they  thought  these  patent 


INFANT   CARE.  65 

foods  needed  only  to  have  water  added  to  them.  All  proprietary- 
foods  are  much  more  expensive  than  when  the  ingredients  are  pur- 
chased separately. 

Most  patent  foods  contain  a  great  deal  of  sugar  and  for  this  reason 
a  baby  may  like  them,  but  this  sugar  is  likely  to  cause  digestive  dis- 
turbances. Babies  fed  on  patent  foods  only  are  sometimes  fat,  but 
even  when  overweight  they  usually  show  symptoms  of  rickets  and 
reduced  power  to  resist  disease.  Scurvy  frequently  follows  the  ex- 
clusive use  of  patent  foods. 

HOW  CLEAN  COW'S  MILK  IS  PRODUCED. 

Since  it  is  so  important  that  the  infant  have  milk  which  is  clean, 
free  from  disease  germs,  and  of  the  proper  composition,  the  con- 
ditions essential  to  producing  such  milk  are  given  in  detail. 

The  cow. 

The  first  essential  is  that  the  cows  shall  be  healthy.  Milk  from  a 
sick  or  diseased  cow  is  not  nourishing  and  it  may  transmit  disease. 
Tuberculosis  is  the  disease  most  to  be  feared.  The  tuberculin  test 
should  be  applied  to  cows  at  least  once  a  year  or  oftener  if  tuber- 
culosis has  been  found  in  the  herd.  A  sick  animal  should  be  imme- 
diately isolated  and  its  milk  discarded. 

To  be  healthy,  animals  must  be  well  fed  and  well  cared  for 
in  decent,  clean  surroundings.  Well-built,  well-aired  stables  are 
necessary. 

The  udder  and  teats  of  the  cow  should  be  washed  with  clean 
water  and  wiped  dry  before  milking.  This  prevents  dust  and  hair 
from  dropping  into  the  pail  during  the  milking. 

The  milker. 

Disease  may  be  carried  from  an  unhealthy  milker  as  well  as  from 
an  unhealthy  cow.  Tuberculosis  and  epidemic  diseases  have  been 
found  to  come  from  diseased  milkers. 

The  hands  of  the  milkers  should  be  washed  clean  and  dried  care- 
fully before  milking.  Milking  with  wet  hands  "is  almost  certain  to 
carry  impurities  into  the  milk.  A  clean  wash  suit  or  jacket  should 
be  worn  while  milking.  The  milker  should  be  very  careful  not  to 
raise  dust  or  permit  any  substance  to  fall  into  the  pail. 

Milking;  utensils. 

A  covered  pail  with  an  opening  not  more  than  5  inches  in  diameter 
should  be  used  for  milking.  This  pail,  strainers,  milk  cans,  and  all 
other  utensils  should  be  washed  clean  and  sterilized  before  using. 

The  water  supply  used  in  washing  the  utensils,  the  udder  of  the 
cow,  and  the  hands  of  the  milker  must  be  clean  and  uncontaminated. 
44527°— 21 5 


66  INFANT   CARE. 

Many  serious  outbreaks  of  disease  have  been  caused  by  a  bad  water 
supply  on  the  farm. 

Refrigeration. 

After  milking,  the  milk  must  be  cooled  quickly  by  standing  in  the 
cans  in  cold  water  or  ice  water.  Milk  should  be  kept  at  a  temper- 
ature below  50°  F. 

CHOICE  OF  MILK. 

Parents  should  know  the  character  of  the  milk  which  is  to  be  given 
to  children.  The  important  factors  are  the  health  of  the  animals 
from  which  the  milk  is  obtained,  the  cleanliness  of  production,  and 
the  care  in  distribution. 

A  dairy  herd  that  is  tuberculin  tested  and  property  inspected 
should  be  chosen.  In  case  of  doubt  the  milk  should  be  pasteurized 
or  scalded  in  the  home. 

In  cities  having  boards  of  health  information  can  be  obtained  at 
that  office  as  to  the  different  dairies.  In  some  cities  monthly  tests 
are  made  of  the  milk  in  all  dairies  and  the  result  is  published  in  the 
newspapers.    A  personal  visit  to  the  dairy  is  most  instructive. 

As  a  rule,  it  is  best  to  obtain  milk  from  a  herd.  There  is  less 
danger  of  getting  milk  from  a  diseased  cow  and  the  milk  varies  less 
in  composition.  Milk  averaging  4  per  cent  fat  is  best  for  infant 
feeding. 

In  cities  none  but  bottled  milk  should  be  bought.  Bulk  or 
"  dipped  "  milk  is  absolutely  unsafe,  also  milk  bottled  by  milkmen  in 
their  wagons  or  bottled  from  the  can  in  a  store.  Too  much  care  can 
not  be  used. 

Where  it  is  not  possible  to  obtain  fresh  milk,  some  form  of  canned 
or  dried  milk  is  the  next  best  substitute. 


CARE  OF  MILK  IN  THE  HOME. 

Milk  must  be  given  proper  care  after  it  is  delivered.  Milk  fre- 
quently becomes  spoiled  by  being  allowed  to  stand  in  the  sun  on  the 
doorstep  or  in  a  warm  kitchen.  It  should  be  placed  immediately  in 
the  ice  box,  where  the  temperature  should  be  below  50°  F.  If  ice  is 
not  available  milk  can  be  kept  at  this  temperature  by  using  an  ice- 
less  refrigerator16  or  standing  the  bottle  in  running  spring  water. 

16 Directions  for  making  iceless  refrigerator.  (Reprinted  from  Farmers' Bulletin  No.  927, 
U.  S.  Department  of  Agriculture,  through  the  courtesy  of  that  department.)  A  wooden 
frame  is  made  with  dimensions  42  by  16  by  14  inches  and  covered  with  screen  wire, 
preferably  the  rustless  type,  which  costs  little  more  than  the  ordinary  kind.  The  door 
is  made  to  fit  closely  and  is  mounted  on  brass  hinges,  and  can  be  fastened  with  a  wooden 
latch.  The  bottom  is  fitted  solid,  but  the  top  should  be  covered  with  screen  wire.  Ad- 
justable shelves  can  be  made  of  solid  wood  or  strips,  or  sheets  of  galvanized  metal. 
Shelves  made  of  poultry  netting  are  probably  more  desirable.     These  shelves  rest  on  side 


INFANT  CARE.  67 

A  spring  house  or  well  may  be  used  to  refrigerate  milk  if  the  water 
is  cold  enough.  The  covered  pail  should  be  placed  in  the  well  so  that 
the  water  comes  up  nearly  to  the  cover.  In  this  way  the  contents  of 
the  pail  may  be  kept  as  cold  as  the  water  outside  the  pail.  In  cool 
climates  bottles  may  be  placed  in  a  pan  of  water  in  an  open  window 
oil  the  cool  side  of  the  house. 

It  is  best  to  keep  milk  until  used  in  the  bottle  in  which  it  comes. 
If  this  can  not  be  done  the  milk  should  be  transferred  to  a  clean,  ster- 
ilized Mason  jar  and  kept  tightly  covered.  The  cover  or  cap  of  the 
milk  bottle  should  be  wiped  off  so  that  no  dust  may  fall  into  the  milk 
when  the  cap  is  removed,  and  before  pouring  out  milk  the  edge  of 
the  bottle  or  jar  should  be  wiped  off  with  a  clean,  dampened  cloth. 
All  bottles,  utensils,  and  the  ice  box  itself  must  be  kept  scrupulously 
clean.    Milk  containers  must  not  be  used  for  any  other  contents. 

A  separate  ice  box  for  the  baby's  milk  is  desirable,  if  possible.  A 
homemade  refrigerator  can  be  made  with  very  little  expense.  A 
small  tin  ice  box  may  be  bought  at  any  department  store  or  large 
hardware  store  and  a  cover  or  "  cozy  "  made  of  felt  or  quilted  cotton. 
By  using  a  well-padded  cover  the  ice  will  last  much  longer  and  the 
inside  temperature  will  remain  constant. 

If  the  family  ice  box  is  to  be  used  it  is  best  to  keep  the  baby's  bot- 
tles in  a  covered  pail,  which  should  be  large  enough  to  hold  all  the 
bottles  for  the  24  hours.  The  pail  should  be  small  enough  to  fit  be- 
tween the  shelves  of  the  ice  box  or  to  go  into  the  ice  compartment. 
A  thermometer  should  be  kept  in  the  pail  with  the  baby's  bottles, 
and  it  should  register  below  50°  F.  at  all  times. 

PREPARATION  FOR  ARTIFICIAL  FEEDING. 
Equipment. 

If  possible,  a  mother  should  procure  the  proper  utensils  for  pre- 
paring artificial  food,  and  these  utensils  should  not  be  used  for  any- 
thing else.    It  may  cost  a  few  dollars  extra,  but  the  proper  equip- 

braces  placed  at  desired  intervals.  A  bread-baking  pan,  14  by  16  inches,  is  placed  on  the 
top,  and  the  frame  rests  in  a  17  by  18  inch  pan.  All  the  woodwork,  the  shelves,  and  the 
pan  should  receive  two  coats  of  white  paint  and  one  or  two  of  white  enamel.  The  screen 
wire  also  should  receive  one  or  two  coats  of  enamel,  as  this  will  prevent  it  from  rusting. 
A  cover  of  canton  flannel,  burlap,  or  duck  is  made  to  fit  the  frame.  Put  the  smooth  side 
out  if  canton  flannel  is  used.  It  will  require  about  3  yards  of  material.  This  cover  is 
buttoned  around  the  frame  and  down  the  side  on  which  the  door  is  not  hinged,  using 
buggy  hooks  and  eyes  or  large-headed  tacks  and  eyelets  worked  in  the  material.  On  the 
front  side  arrange  the  hooks  on  the  top  of  the  latch  side  of  the  door,  allowing  a  wide 
hem  of  the  material  to  overlap  the  place  where  the  door  closes.  The  door  can  then  be 
opened  without  unbuttoning  the  cover.  Four  double  strips,  which  taper  to  8  or  10  inches 
in  width,  are  sewed  to  the  upper  part  of  the  cover.  These  strips  form  wicks  that  dip 
into  the  upper  pan.  If  a  larger  capacity  is  desired,  the  height  of  the  refrigerator  can  be 
increased.  (Farmers'  Bulletin  No.  929,  IT.  B.  Department  of  Agriculture,  gives  photo- 
graphs of  a  finished  iceless  refrigerator;  also  explanation  of  its  operation.  Sent  free 
upon  written  request  to  Division  of  Publications,  U.  S.  Department  of  Agriculture.) 


68  INFANT   CARE. 

ment  used  only  for  the  baby's  food  will  save  much  time  and  trouble 
every  day.    The  following  is  a  list  of  needed  equipment: 

1.  Nursing  bottles  (12)  holding  8  ounces.  (It  is  cheaper  to  buy 
them  by  the  dozen,  but  there  should  be  at  least  one  more  than  the 
number  of  feedings  in  24  hours.) 

2.  Nipples  (12).    Fresh  nipple  for  each  feeding. 

3.  Nonabsorbent  cotton,  or  rubber  corks. 

4.  Bottle  brush. 

5.  Bottle  rack  or  container.  (May  be  made  at  home  from  a  small 
pail  by  fitting  wires  to  hold  the  bottles  apart.) 

6.  Crockery  or  enamel  2-quart  pitcher  for  mixing. 

7.  Glass  graduate  (measuring  glass)  holding  at  least  8  ounces, 
graduated  in  one-half  ounces. 

8.  Measuring  spoons  (table,  tea,  and  half-tea  sizes). 

9.  Mixing  spoons  (table  size) . 

10.  Fork  for  removing  cap  from  milk  bottle. 

11.  Double  boiler,  holding  2  quarts. 

12.  Saucepan,  for  boiling  water  or  scalding  milk. 

13.  Flat-bottomed  enamel- ware  kettle  or  pail  with  a  lid,  18  inches 
in  diameter,  holding  1  gallon  and  fitted  with  false  bottom  for  steriliz- 
ing utensils. 

14.  Enamel-ware  funnel. 

15.  Knife  for  leveling. 

16.  Small  glass  jars  with  covers  for  nipples  (one  for  clean  and  one 
for  used  nipples). 

Preparation  of  the  bottle  feedings. 

The  hands  of  the  mother,  the  utensils,  and  everything  that  touches 
or  comes  near  the  food  should  be  perfectly  clean.  Clean  milk  can  be 
spoiled  by  dirty  handling. 

Bottles. — Selection  of  bottles  is  important.  It  is  most  important 
that  every  part  of  the  inside  of  a  bottle  be  easily  reached  by  the 
bottle  brush  and  that  there  are  no  corners  which  can  not  be  cleaned. 
The  neck  of  the  bottle  should  slope  gradually  into  the  body  of  the 
bottle,  and  the  bottom  of  the  bottle  should  also  slope  into  the  sides 
without  a  sharp  corner.  New  bottles  should  be  washed  thoroughly 
in  hot  suds,  rinsed  with  cold  water,  and  boiled  before  using.  All 
bottles  should  always  be  boiled  for  five  minutes  before  they  are  used. 
After  a  bottle  is  emptied  it  should  be  well  rinsed  at  once  in  cold 
water,  and  then  filled  with  cold  water,  and  put  in  a  clean  place  away 
from  flies  and  dust  until  all  the  bottles  for  a  day's  feeding  can  be 
conveniently  washed  and  sterilized. 

Nipples. — The  most  important  thing  about  choosing  nipples  is  to 
select  the  kind  which  can  easily  be  turned  inside  out  to  be  cleaned. 
A  nipple  that  can  not  be  cleaned  in  this  way  is  unsafe  to  use.  It  is 
best  to  buy  nipples  without  holes,  and  to  make  one  hole  near  the  top 


INFANT  CARE.  69 

with  a  fine,  hot  sewing  needle.  If  nipples  are  bought  with  holes  it 
is  often  necessary  to  enlarge  the  holes  with  a  heated  needle.  The 
holes  should  be  large  enough  to  allow  the  milk  to  drop  rapidly,  but 
not  to  flow  in  a  steady  stream,  when  the  bottle  is  turned  upside  down. 
New  nipples  should  be  rubbed  inside  and  out  with  the  hand  or  with 
a  stiff  brush  until  the  white  coating  is  entirely  removed,  then  thor- 
oughly washed  in  hot  suds,  rinsed,  covered  with  cold  water,  and 
boiled  before  using.  All  nipples  should  always  be  boiled  for  five 
minutes  before  they  are  used.  Keeping  nipples  in  boiled  water  or 
in  antiseptic  solutions  is  not  wise,  because  bacteria  may  grow  in  such 
fluids.  Clean  sterilized  nipples  should  be  kept  in  a  sterile  covered 
glass  jar.  After  a  feeding  the  nipple  should  be  turned  and  rinsed 
inside  and  out  in  cold  water,  and  put  away  in  a  covered  jar  until 
sterilized  for  the  following  day.  It  is  important  to  use  a  fresh  nip- 
ple for  each  feeding. 

Sterilising  ute?isils. — Bottles,  nipples,  mixing  pitcher,  measuring 
spoons,  graduate,  and  other  utensils  that  are  to  be  used  in  mixing  the 
baby's  food  should  be  washed  in  hot  suds,  rinsed  in  clean,  hot  water, 
and  boiled  for  five  minutes  before  using. 

Mixing  the  food. — Take  the  bottle  of  milk  from  the  ice  box  and 
wipe  the  top  carefully  with  a  clean  towel  dipped  in  boiling  water 
before  the  cap  is  removed.  Have  at  hand  the  boiled  water,  cereal 
water,  or  gruel  already  prepared  and  cooled  (see  p.  99).  Wash  the 
hands  carefully.  Eemove  from  the  stove  the  container  in  which  the 
utensils  were  boiled.  Without  touching  the  tops  or  insides  take  out 
all  the  utensils  and  place  them  right  side  up  on  a  clean  table  pre- 
viously covered  with  a  clean  towel.  Place  the  nipples  in  a  sterile 
glass  and  cover.  Measure  the  sugar  in  a  measuring  spoon  and  place 
it  in  the  glass  graduate.  Measure  the  boiled  water  or  cereal  water 
in  the  same  glass  graduate  and  dissolve  the  sugar  in  the  water. 
Empty  the  contents  of  the  graduate  into  the  mixing  pitcher.  Meas- 
ure the  milk  to  be  used  in  the  graduate  and  add  this  to  the  water  and 
sugar  in  the  pitcher  and  stir  with  the  large  mixing  spoon.  Fill  the 
bottles  with  the  correct  amount  for  each  feeding,  measuring  it  only 
in  the  glass  graduate,  not  by  the  marks  on  the  nursing  bottles  be- 
cause they  are  less  accurate.  Stopper  the  bottles  with  cotton  or 
corks,  or  cover  them  with  squares  of  wax  paper  held  down  by  rubber 
bands. 

Cool  the  bottles  and  contents  quickly  by  standing  them  in  run- 
ning water.  Then  place  the  bottles  in  the  bottle  rack  and  keep  them 
cold  (below  50°  F.)  until  used. 

WHAT  MILK  MIXTURE  TO  FEED  THE  BABY. 

Every  baby  should  be  under  the  supervision  of  a  physician,  and 
at  no  time  is  this  more  necessary  than  when  artificial  feeding  is 


70  INFANT   CARE. 

begun.  Cow's  milk  should  be  the  principal  food  during  the  first  two 
years  of  life.  Whole  cow's  milk,  properly  diluted  with  boiled  water 
with  the  addition  of  sugar,  is  usually  suited  to  the  average  baby 
under  1  year  of  age. 

No  single  method  of  artificial  feeding  can  possibly  meet  the  needs 
of  all  infants.  The  methods  given  in  the  following  are  simple,  prac- 
tical, and  safe.  These  methods  are  adaptable  to  the  needs  of  the 
majority  of  well  babies. 

Milk. 

During  the  first  three  weeks  of  life  the  baby  usually  requires  not 
more  than  1  ounce  per  pound  of  body  weight. 

After  the  first  two  or  three  weeks  of  the  infant's  life  and  as  long  as 
milk  is  the  chief  food,  babies  usually  require  not  less  than  1J  ounces 
of  milk  to  a  pound  of  body  weight. 

[To  illustrate:  A  well  infant  5  months  old,  weighing  14  pounds, 
should  take  in  24  hours  1-J  ounces  of  milk  for  every  pound  he  weighs 
(1-J  times  14),  or  21  ounces  of  milk.  If  the  baby  has  never  taken 
cow's  milk,  it  is  better  to  start  with  a  smaller  quantity  of  milk — for 
instance,  1  ounce  to  a  pound  of  body  weight,  or  14  ounces  of  milk — 
and  increase  this  as  rapidly  as  possible  to  the  full  amount  required, 
namely,  1|  ounces  to  a  pound  of  body  weight.] 

Whether  breast  fed  or  bottle  fed,  every  baby  should  learn  to  take 
whole  cow's  milk  by  the  end  of  the  first  year,  preferably  drinking 
from  a  cup  at  this  age.  It  is  rarely  necessary  to  give  more  than  1 
quart  of  cow's  milk  in  24  hours.  When  this  is  insufficient  nourish- 
ment other  foods  should  be  added  to  the  diet. 

Water. 

At  first  cold  boiled  water  should  be  used  for  diluting  the  milk,  and 
increasing  the  total  amount  of  fluid  necessary  in  24  hours.  By  the 
third  month  or  any  time  thereafter,  a  cereal  water 17  may  be  used  to 
dilute  the  milk  instead  of  plain  water.  The  amount  of  water  to  be 
added  to  the  milk  is  calculated  by  multiplying  the  number  of  feedings 
in  24  hours  by  the  amount  of  each  feeding.  This  gives  the  total 
amount  of  food  mixture.  Subtract  from  this  the  total  amount  of 
milk  to  be  given  (1-J  ounces  for  each  pound  of  weight)  and  the  result 
will  be  the  amount  of  water  to  be  used. 

[To  illustrate:  Baby  aged  4  months,  weighing  12  pounds,  and 
taking  5  feedings  of  6  ounces  each — 

5X6  =30  ounces  of  food  mixture. 
12X11=18  ounces  of  milk  to  be  given. 

12  ounces  of  water  to  be  added.] 

"See  p.  99. 


INFANT  CARE.  71 

The  amount  of  water  is  diminished  as  the  amount  of  milk  is  in- 
creased, unless  it  is  necessary  to  increase  the  total  amount  of  fluid 
given.     (See  table  of  feeding  intervals  and  amounts,  p.  74.) 

Cool  boiled  water  should  be  offered  to  every  child  several  times  a 
day  between  feedings.  The  amount  of  water  he  takes  depends 
largely  on  the  forethought  of  his  mother.  A  child  at  1  year  should 
take  at  least  8  ounces  a  day,  and  more  in  warm  weather. 

Sugar. 

Three  kinds  of  sugar  are  commonly  used  in  infant  feeding — cane 
sugar  (ordinary  granulated  sugar),  milk  sugar,  and  malt  sugar. 
For  most  babies  cane  sugar  is  perfectly  satisfactory. 

One  level  tablespoonful  (-J  ounce  by  weight)  of  granulated  sugar 
should  be  added  to  the  total  milk  mixture  for  each  5  pounds  that  the 
baby  weighs.  Not  more  than  3  level  tablespoon fuls  of  granulated 
sugar  should  ever  be  added  to  the  total  quantity  of  milk  mixture  for 
24  hours  at  any  age. 

One  and  one-half  level  tablespoonfuls  of  milk  sugar  equals  1  table- 
spoonful  of  cane  sugar  (-|  ounce  by  weight) . 

Sugar  is  gradually  increased  in  amount  with  the  increase  in  the 
strength  and  quantity  of  the  formula.  By  the  eighth  month  the 
child  may  be  given  3  level  tablespoonfuls  of  cane  sugar  or  4J  level 
tablespoonfuls  of  milk  sugar  to  the  day's  milk  mixture,  but  that  is 
the  maximum  amount  of  sugar  ever  allowed.  From  this  age  on  the 
sugar  is  gradually  decreased  so  that  by  1  year  of  age  the  child  takes 
whole  milk  unsweetened. 

Alkalies. 

Lime  water  or  other  alkalies  do  not  need  to  be  added  to  the  milk 
mixtures  of  healthy  babies. 

ADDITIONS  TO  DIET  UNDER  ONE  YEAR. 
Starches. 

To  increase  the  food  value  of  the  baby's  diet,  and  to  promote  the 
clotting  of  the  milk  into  fine  curd,  starch  in  the  form  of  a  thin  flour 
or  cereal  water  or  a  thick  gruel,  according  to  the  age  of  the  baby,  is 
at  times  used  to  dilute  the  milk  in  place  of  all  or  part  of  the  boiled 
water. 

By  the  third  month  cereal  water  can  be  added  to  the  milk  mixture 
in  place  of  water.  Thick  gruel18  in  small  quantities  (1  tablespoon- 
ful) can  be  given  by  the  sixth  month.  This  quantity  can  be  in- 
creased to  2  tablespoonfuls  twice  daily  and  fed  from  a  saucer  at 
regular  feeding  time  by  pouring  some  of  the  bottle  milk  over  it ;  the 
meal  being  finished  by  taking  the  remainder  of  the  bottle. 

18  See  p.  100. 


72  INFANT   CARE. 

By  the  seventh  month  bread  cut  thin  and  dried  in  the  oven  or 
homemade  zwieback  may  be  given  once  a  day  to  teach  the  baby  to 
chew  and  manage  crumbs.  Home  goods  are  always  safer  for  the  baby 
than  store  purchases  or  bakery  goods,  for  the  exact  amount  and 
kind  of  the  ingredients  are  known  and  there  is  less  danger  of  their 
being  insufficiently  baked  or  containing  too  much  sugar  or  shortening. 

Fruit  juices. 

Orange  juice  may  be  started  by  the  third  month.  If  oranges  are 
not  available,  canned  tomato  juice  may  be  substituted.  This  is  not 
economical  for  home  use  because  of  the  necessity  of  opening  fresh 
cans  of  tomatoes  daily.  The  amount  at  first  should  not  be  more  than 
1  teaspoonful.  This  should  be  gradually  increased  to  1  table- 
spoonful  by  the  second  half  of  the  year,  and  to  1  or  2  ounces  by  the 
end  of  the  first  year.  The  quantity  of  juice  should  always  be  diluted 
with  an  equal  amount  of  water  and  should  be  given  one-half  hour 
before  feeding,  preferably  between  morning  feedings.  By  12  months 
of  age  the  juice  of  fresh,  ripe  fruit  may  be  given,  such  as  pineapple, 
peaches,  pears,  and  apricots ;  and  also  apple  sauce. 

Vegetables. 

Strained  vegetable  soup  may  be  added  to  the  diet  any  time  after 
the  sixth  month.  It  can  be  added  at  the  time  of  feeding,  replacing 
1  ounce  of  the  milk  mixture  or  placed  in  the  milk  mixture. 

By  the  ninth  month  well  bottle-fed  babies  may  be  given  1  or  2  tea- 
spoonfuls  of  vegetable  pulp,  made  by  boiling  vegetables  very  soft  and 
putting  them  through  a  fine  wire  sieve,  or  5  to  6  ounces  of  vegetable 
soup  may  be  given  and  the  quantity  gradually  increased  in  amount, 
so  that  by  the  end  of  the  first  year  the  baby  is  receiving  8  ounces  of 
vegetable  soup. 

Beef  juice. 

Beef  juice  may  be  given  after  the  tenth  month.  Begin  with  1 
teaspoonful  and  increase  to  1  tablespoonful. 

FEEDING  RULES. 
Feeding  intervals. 

During  the  first  and  second  month,  3-hour  intervals — 6  or  7  feed- 
ings in  24  hours  (6  a.  m.,  9  a.  m.,  12  m.,  3  p.  m.,  6  p.  m.,  10  p.  m., 
and  2  a.  m.,  if  needed),  or  5  or  6  feedings  on  a  4-hour  schedule  (6 
and  10  a.  m. ;  2,  6,  and  10  p.  m. ;  and  2  a.  m.,  if  necessary). 

During  third  month,  3-hour  intervals — 6  feedings  in  24  hours 
(6  a.  m.,  9  a.  m.,  12  m.,  3  p.  m.,  6  p.  m.,  and  10  p.  m.),  or  5  feedings 
on  a  4-hour  schedule  (6  and  10  a.  m. ;  2,  6,  and  10  p.  m.). 

During  and  after  fourth  and  fifth  months,  4-hour  intervals — 5  feed- 
ings in  24  hours  (6  a.  m.,  10  a.  m.,  2  p.  m.,  6  p.  m.,  10  p.  m.) . 


INFANT   CARE.  73 

Amounts  at  each  feeding. 

On  3-hour  intervals  the  quantity  should  be  1  ounce  more  than  baby 
is  months  old.  Example:  A  3-months-old  baby  takes  4  ounces  per 
feeding  if  fed  every  3  hours. 

On  4-hour  intervals,  the  quantity  is  2  ounces  more  than  the  baby  is 
months  old.  Example  :  A  6-months-old  baby  takes  8  ounces  per  feed- 
ing on  4-hour  schedule. 

The  increases  per  feeding  are  made  gradually  until  the  feedings 
reach  8  ounces. 
Giving  the  bottle. 

At  feeding  time  the  bottle  of  modified  milk  is  removed  from  the 
ice  box,  the  cotton  or  rubber  stopper  removed,  and  a  clean,  sterile 
nipple  from  the  sterile  jar  put  on  it.  The  hands  that  put  on  the 
nipples  should  be  freshly  washed  and  clean,  and  only  the  rim  of  the 
nipple  should  be  touched  in  putting  it  on.  The  bottle  is  then  heated 
by  standing  it  in  warm  water  in  a  vessel,  such  as  a  pint  cup,  for 
which  a  false  bottom  has  been  made  by  dropping  in  a  tin  jelly  top  in 
which  holes  have  been  punched.  Bottle  warmers  may  be  purchased 
in  any  hardware  store  but  are  no  better  than  the  homemade  variety. 
The  water  around  the  bottle  should  be  warm  to  start  with  and 
should  be  heated  rapidly.  Great  care  must  be  taken  not  to  have  the 
contents  of  the  bottle  overheated  or  cooked.  Usually  the  contents  of 
the  bottle  is  sufficiently  warm  (100°  F.)  before  the  water  in  the  con- 
tainer has  boiled.  The  warmth  of  the  milk  in  the  bottle  may  be  tested 
by  letting  a  few  drops  trickle  from  the  nipple  on  the  mother's  wrist, 
where  it  should  feel  pleasantly  warm  but  not  hot.  The  nipple  should 
not  be  touched  or  come  in  contact  with  anything  until  it  reaches  the 
baby's  mouth. 

A  baby  should  be  held  while  taking  the  bottle,  or  lie  on  his  side  in 
the  crib  while  the  bottle  is  held  in  place  for  him.  A  semiupright 
position  is  best  if  there  is  a  disturbance  caused  by  gas.  Twenty  min^ 
utes  is  the  longest  time  and  10  minutes  the  shortest  time  that  should 
be  allowed  for  taking  a  bottle. 

After  nursing  or  feeding,  the  infant  should  be  raised  carefully  to 
the  mother's  shoulder  and  patted  several  times  on  the  back  with  the 
flat  of  the  hand  to  bring  up  the  gas,  or  air  swallowed  with  the  food. 
Some  babies  need  to  be  taken  up  during  nursing  or  feeding  for  this 
purpose. 

GROWTH. 

The  chief  difference  between  a  well  breast-fed  and  a  well  bottle- 
fed  baby,  both  of  whom  are  receiving  enough  food,  is  that  the  gain 
of  the  former  is  apt  to  be  greater,  especially  during  the  first  six 
months  of  life. 

After  artificial  food  has  been  adjusted  to  the  baby's  needs,  an 
average  weekly  gain  of  4  or  5  ounces  is  all  that  need  be  expected. 


74  INFANT  CARE. 

An  average  bottle-fed  baby  may  be  expected  to  nearly  double  its 
birth  weight  by  the  sixth  month  and  treble  its  birth  weight  by  the 
end  of  the  first  year. 

DIFFICULTIES  OF  THE  ARTIFICIALLY  FED  BABY. 

Stools, 

The  stools  of  an  artificially  fed  baby  are  quite  different  from 
those  of  a  breast-fed  baby.  They  are  almost  always  fewer  in  number, 
frequently  only  one  in  24  hours.  The  movements  are  much  firmer, 
often  formed,  and  with  slight  odor.  The  color  differs,  according  to 
the  food,  from  lemon  yellow,  if  cow's  milk  is  the  sole  food,  to  dark 
or  light  brown,  if  malt  products  or  starchy  gruels  are  used.  A  well 
baby's  stool  should  be  smooth  and  somewhat  pasty  in  character, 
showing  that  the  food  is  well  digested.  Loose,  green,  frequent  stools, 
or  hard,  greasy,  marble-like  movements  are  symptoms  of  disturbance 
and  indicate  the  necessity  of  some  change  in  diet. 

Underfeeding. 

Underfeeding  may  be  caused  either  by  not  feeding  enough  of  the 
right  food  or  by  feeding  the  wrong  kind  of  food.  Underfed  infants 
usually  sleep  for  shorter  periods  and  fret  and  cry  before  the  regular 
feeding  period.  If  the  baby  fails  to  make  regular  gains  in  weight, 
the  food  either  needs  to  be  increased  in  quantity  or  properly  modified 
to  suit  the  baby's  needs.  No  two  infants  have  exactly  the  same 
ability  to  utilize  food. 

Overfeeding. 

Overfeeding  is  one  of  the  most  common  causes  of  digestive  dis- 
turbances in  artificially  fed  infants.  Babies  cry  and  fret,  frequently 
not  because  they  are  hungry  but  because  they  are  uncomfortable 
from  being  given  more  food  than  they  can  digest.  Stationary  weight 
is  not  uncommon  when  the  food  is  pushed  beyond  the  needs  and  the 
digestive  capacity  of  the  child. 

The  overfed  baby  may  take  all  that  is  given  him  and  cry  for  more, 
or  he  may  leave  some  of  his  bottle.  Overfeeding  is  frequently  due 
to  too  rapid  increase  in  quantity  and  strength,  or  to  too  frequent 
feedings.  Regurgitation  (spitting  up)  or  vomiting  may  be  a  symp- 
tom of  overfeeding. 

SUMMARY  OF  ARTIFICIAL  FEEDING  TO  1  YEAR.™ 
Birth: 

Average  weight,               Boiled  water.  1  to  2  ounces  every 

7  pounds.  4  hours. 
1st  week: 

Average  weight,               Whole  milk.  7  ounces. 

7  pounds  or  less.                 Boiled  water.  14  ounces. 

Cane  sugar.  1  level  tablespoonful. 

Offer  3  ounces  every  3  hours.     Total  7  feedings  in  24  hours. 

19  Based  on  three-hourly  schedule  up  to  4  mouths. 


INFANT  CARE.  75 

2  weeks: 

Average  weight,  Whole  milk.  8  ounces. 

7  pounds.  Boiled  water.  13  ounces. 

Cane  sugar.  2  level  tablespoonfuls. 

Offer  3  ounces  every  3  hours.     Total  7  feedings  in  24  hours. 

3  weeks: 

Average  weight,  Whole  milk.  9  ounces. 

T3  pounds.  Boiled  water.  12  ounces. 

Cane  sugar.  2  level  tablespoonfuls. 

Give  3  ounces  every  3  hours.     Total  7  feedings  in  24  hours. 

I  month. 

Average  weight,  Whole  milk.  11  ounces. 

8  pounds.  Boiled  water.  10  ounces. 

Cane  sugar.  2  level  tablespoonfuls. 

Give  3  ounces  every  3  hours.     Total  7  feedings  in  24  hours. 

3  months: 

Average  weight,  Whole  milk.  17  ounces. 

II  pounds.  Boiled  or  cereal  water.30  11  ounces. 

Cane  sugar.  2  level  tablespoonfuls. 

Give  4  ounces  every  3  hours.     Total  7   feedings,  or  if  2  a.  m.   feeding  is 
eliminated,  give  4 i  ounces  for  6  feedings. 

Orange  juice  (see  p.  72). 

4  months: 

Average  weight,  Whole  milk.  18  ounces* 

12  pounds.  Boiled  or  cereal  water.         12  ounces. 

Cane  sugar.  2\  level  tablespoonfuls. 

Give  6  ounces  every  4  hours.     Total  5  feedings  in  24  hours. 

Orange  juice. 
6  months: 

Average  weight,  Whole  milk.  21  ounces. 

14  pounds.     (Birth  Boiled  or  cereal  water.  19  ounces, 

weight   doubled.)  Cane  sugar.  2£  level  tablespoonfuls. 

Offer  8  ounces  every  4  hours.    Total  5  feedings  in  24  hours. 
Orange  juice. 
Cooked  cereal.31 
Vegetable  soup.22 

9  months: 

Average  weight,  Whole  milk.  27  ounces. 

18  pounds.  Plain    boiled    or     cereal      13  ounces. 

water.  2£  level  tablespoonfuls. 

Cane  sugar. 
Give  8  ounces  every  4  hours.    Total  5  feedings  in  24  hours. 
Orange  juice. 
Cooked  cereal. 
Vegetable  soup. 
Note. — If  milk  sugar  is  used  1|  tablespoonfuls  should  be  used  in  place  of  1  of 
cane  sugar. 

20  See  recipe,  p.  99.  21  see  p.  99.  *  See  p.   102. 


76  INFANT  CABE. 

12  months: 

Average  weight,  21  pounds.     (Birth  weight  trebled.) 
6  a.  m.  Whole  milk,  8  ounces,  or 

Milk,   6   ounces,    diluted    with    barley    or    oat    gruel,    2    table^ 
spoonfuls. 
9  a.  m.  Fruit  juice,  1  to  2  ounces,  diluted  with  water,  1  to  1  ounce 
(or  may  be  given  at  5  p.  m.). 
10  a.  m.  Cooked  cereal,  or   cereal   jelly,   1  to  3  tablespoonfuls,   served 
with  milk. 
Milk,  6  ounces,  to  drink. 
*>,  p.  m.  Vegetable  soup,  8  ounces,  served  with  bread  crumbs,  or 

Green  vegetables,  1  to  2  tablespoonfuls,  mashed  or  finely  divided, 
and  1  to  2  tablespoonfuls  beef  juice  with  1  tablespoonful  of 
well  cooked  rice,  or  barley,  or  macaroni,  or  spaghetti. 
Milk,  8  to  10  ounces. 
6  p.  in.  Milk,  6  to  8  ounces,  with 

Dried  bread,  \  slice  or  gruel,  1  to  2  tablespoonfuls. 

THE  BABY  FROM  1  TO  2  YEARS. 

FOOD. 

Infancy  is  usually  considered  to  cover  only  the  first  two  years  of 
life ;  in  reality  it  can  not  be  so  sharply  defined,  but  should  include  at 
least  the  period  before  the  first  20  teeth  are  cut.  During  the  year 
or  more  that  immediately  follows  breast  feeding  one  of  the  most  im- 
portant and  fundamental  changes  in  the  child's  entire  history  should 
take  place.  This  is  the  transition  from  liquid  food  to  a  solid  diet. 
At  this  time  the  child  should  be  taught  to  take  a  well-balanced  diet, 
especially  an  abundance  of  growth-producing  foods. 

Proper  food  habits  must  be  acquired  at  this  time,  or  they  are  likely 
never  to  be  acquired.  Every  child  should  be  trained  to  take  the  right 
amount  and  the  right  kind  of  food,  and  to  eat  at  regular  hours.  Fast 
eating  or  washing  down  unchewed  food  with  liquids  should  be  pro- 
hibited. The  young  child  tends  to  bolt  his  food  without  careful 
chewing ;  he  must  be  given  food  that  demands  chewing  and  be  taught 
to  chew  it.  Both  good  digestion  and  perfect  nutritive  condition  de- 
pend largely  on  the  observance  of  these  details. 

Few  mothers  realize  the  importance  of  this  transition  period  be- 
tween the  diet  of  infancy  and  that  of  childhood.  Some  make  the 
mistake  of  keeping  the  baby  too  long  on  milk  as  the  exclusive  or 
nearly  exclusive  food.  Many  others  unthinkingly  give  the  tiny  baby 
tastes  of  anything  they  happen  to  be  eating,  without  thinking  whether 
or  not  it  is  nourishing  or  suitable  for  an  infant.  In  either  case  the 
baby  fails  to  learn  to  eat  the  food  that  is  good  for  him,  and  often  his 
digestion  is  upset  as  well.  Much  of  the  sickness  and  malnutrition 
of  older  children  can  be  traced  back  to  carelessness  in  feeding  at  this 
period  or  lack  of  discipline  in  enforcing  proper  food  habits. 


INFANT   CARE.  77 

For  the  best  growth  and  development  every  child's  food  must 
contain  an  abundance  of  animal  protein — found  especially  in  milk, 
eggs,  meat,  fish,  and  fowl — minerals,  and  vitamines,  whose  chief 
sources  are  milk,  green  vegetables,  fruit,  eggs,  and  meat.  Starchy 
foods  are  also  a  necessary  part  of  the  diet  of  every  well  child  and 
indeed  form  the  bulk  of  the  food.  Starch,  sugar,  and  fat  furnish 
body  heat  and  may  be  called  "  energy  foods." 

The  growth  and  energy-producing  foods  necessary  for  healthy  de- 
velopment are : 

1.  Milk. 

2.  Starchy  foods,  such  as  cereals,  potato,  bread,  and  rice. 

3.  Fruits. 

4.  Green  vegetables. 

5.  Butter. 

6.  Eggs. 

7.  Meat,  fish,  and  fowl. 

Every  mother  should  be  aware  of  the  nature  and  value  of  each  of 
these  foods  and  know  how  best  to  prepare  them  for  infant  use. 

Milk. 

After  1  year,  as  other  foods  are  added  to  the  diet,  the  baby  will 
take  less  milk,  but  the  amount  should  be  at  least  1J  pints  of  milk  a 
day.  Weaning  from  the  bottle  should  be  begun  before  1  year,  so 
that  by  13  or  14  months  the  baby  drinks  from  a  cup.  It  is  harmful 
to  continue  bottle  feeding  beyond  this  time. 

Starches. 

Thoroughly  cooked  cereal,  such  as  farina,  cream  of  wheat,  barley, 
rice,  or  oatmeal,  should  be  given  every  morning,  and  may  be  repeated 
at  the  evening  meal,  as  the  child  grows  older.  From  1  to  4  table- 
spoonfuls  of  cereal  may  be  given  at  a  meal.  Ready-to-serve  package 
cereals  are  not  as  good  for  children  as  cooked  cereals.     (See  p.  99.) 

Vegetables. 

During  the  second  year  a  well  child  should  take  8  ounces  of  vege- 
table soup  or  two  or  three  heaping  tablespoon fuls  of  vegetable  puree 
at  his  noon  meal. 

The  following  cooked  vegetables  are  allowed:  Peas,  string  beans, 
carrots,  spinach,  celery,  lettuce,  aspargus  tips,  young  beets,  young 
onions  and  artichokes.  All  of  these  vegetables  must  be  put  through 
a  fine  sieve.  Spinach,  carrots,  or  other  vegetables  may  appear  in  the 
stools,  unchanged,  but  this  may  be  disregarded  if  there  are  no  signs 
of  indigestion.    Dried  peas  and  beans  may  be  given  in  purees. 

Tubers,  such  as  potato,  should  not  be  considered  as  green  vegeta- 
bles. They  are  in  reality  largely  starch,  and,  although  valuable  for 
their  mineral  content,  do  not  take  the  place  of  leaf  or  root  vegetables 
in  the  diet.    By  14  months  a  starchy  vegetable  or  food  such  as  potato 


78  INFANT  CARE. 

or  rice,  macaroni  or  spaghetti  may  be  given  with  vegetable  soup  or 
boiled  vegetables  at  dinner.  Rice,  macaroni,  spaghetti,  or  barley 
may  be  given  in  the  soup. 

Eggs  or  meat. 

Eggs  should  be  added  to  the  diet  by  14  months.  They  should  be 
soft'  boiled  or  coddled.  They  should  be  given  at  the  noon  meal.  Beef 
juice  or  scraped  meat  may  be  given  in  place  of  eggs. 

Fruits. 

By  the  end  of  the  eighteenth  month,  the  baby  should  be  taking 
orange  pulp  or  scraped  apple,  and  the  pulp  of  cooked  and  strained 
fruits  such  as  apples  and  prunes  or  home-canned  fruits  or  well- 
cooked  dried  fruits. 

Water. 

Babies  at  2  years  can  ask  for  a  drink  of  water.  At  this  age  a 
child  is  usually  allowed  all  the  water  he  wants,  between  meals.  Un- 
less the  water  supply  is  of  unquestionable  purity  the  water  should 
still  be  boiled. 

FEEDING  INTERVALS. 

At  the  end  of  the  first  year,  the  baby  should  be  taking  his  food 
every  four  hours,  having  not  more  than  4  meals  in  24  hours. 

After  14  months  the  meals  take  on  the  character  of  breakfast, 
dinner,  and  supper,  with  milk  the  first  thing  in  the  morning  or  before 
the  nap  at  10  or  11  a.  m. 

Nothing  but  water  or  fruit  juice  should  be  given  between  meals. 

GROWTH. 

The  average  yearly  gain  during  the  second  year  is  6  pounds.  At 
2  years  of  age  a  child  usually  weighs  25  to  26  pounds. 

Twelve  inches  is  the  average  gain  in  height  during  the  first  two 
years,  so  that  at  2  years  the  average  height  of  an  infant  is  32  inches. 

SUMMARY  OF  FEEDING,  14  MONTHS  TO  2  YEARS. 

9  a.  m.  Milk,  8  ounces ;  crisp  toast  or  zwieback,  small  slice. 
9  a.  m,  Fruit  juice,  or  pulp,  1  to  2  ounces. 
10-10.30  a.  m.  Cereal,  3  to  4  heaping  tablespoonf uls,   strained  or  unstrained ; 
upon  this,  milk  and  a  pinch  of  salt. 
Milk,  4  to  6  ounces  to  drink; 
Crisp  toast,  dry  bread,  or  zwieback,  1  slice. 

Notb. — 10  a.  m.  and  7  a.  m.  feedings  may  be  reversed. 
2  p.  m.  Meat  or  egg : 

1  egg,  soft  boiled  or  coddled ; 

or, 
beef  juice,  2  ounces ; 

or, 
scraped  beef  or  lamb  or  minced  chicken,  1  to  2  tablespoonf  uls ; 
and 


INFANT   CARE.  79 

Vegetable : 

Vegetable  soup,  8  ounces; 

or, 
1  starchy  food  a  and  1  green  vegetable,23  2  or  3  tablespoonfuls ; 
and 
Bread :  Dried  toast  or  zwieback,  1  slice ; 

and 
Simple  dessert :  1-2  tablespoonfuls  junket,  boiled  custard,  gelatin, 
cornstarch,  rice  pudding,  or  prune  whip. 
6  p.  m.    Milk,  8  ounces. 

Dried  toast  or  zwieback,  1  slice. 

Cereal,  3  heaping  tablespoonfuls;  upon  this  milk  and  a  pinch  of 

salt. 
Cooked  fruit,  1  or  2  tablespoonfuls. 

THE  SICK  BABY. 

A  mother  should  know  the  ordinary  symptoms  of  disease  in  order 
to  decide  when  it  is  necessary  to  send  for  a  doctor.  As  she  usually 
acts  as  nurse,  she  should  also  understand  the  essential  principles  of 
caring  for  the  sick. 

A  sick  ^baby  is  a  difficult  problem.  He  can  not  explain  his  suffer- 
ing- or  discomfort,  and  the  observation  of  the  mother  must  overcome 
this  handicap.  A  young  child  often  becomes  ill  with  alarming  sud- 
denness and  may  be  desperately  ill  in  a  short  time.  Prompt  and 
skillful  nursing  is,  therefore,  more  necessary  with  children  than 
with  adults. 

WHAT  A  MOTHER  SHOULD  NOTE. 

The  mother  should  learn  to  read  a  clinical  thermometer  so  that 
she-  may  know  whether  or  not  her  child  has  a  fever.  A  thermometer 
may  be  purchased  at  any  drug  store  and  her  doctor  or  the  druggist 
will  be  glad  to  show  her  how  to  read  it. 

The  baby's  temperature  normally  ranges  from  98.6°  to  99.5°  F. 
The  temperature  of  a  baby  is  much  more  variable  than  that  of  an 
adult,  and  a  temperature  higher  than  99.5°  F.  is  not  unusual  even  in 
babies  who  are  not  sick.  If  the  temperature  is  higher  than  100°  F. 
the  doctor  should  be  notified.  A  baby's  temperature  should  always 
be  taken  in  the  rectum.  It  is  wise  to  purchase  a  thermometer  with  a 
thick  bulb  for  taking  a  rectal  temperature.  The  bulb  should  be 
smeared  with  vaseline  or  oil  and  inserted  into  the  rectum  for  at  least 
an  inch.  The  thermometer  should  be  held  in  the  rectum  for  at  least 
three  minutes  and  care  taken  that  the  baby  is  kept  quiet  so  that  there 
is  no  possibility  of  breaking  the  thermometer.  In  most  cases  it  is 
just  as  well  not  to  take  the  temperature  frequently  because  it  may 
cause  unnecessary  worry  to  the  mother  and  annoyance  to  the  baby. 

Children  are  more  likely  to  have  fever  than  grown  persons.  A 
rise  in  temperature  frequently  accompanies  even  a  slight  upset  in 

«  See  p.  77. 


80  INFANT  CARE. 

children,  but  a  continuous  fever,  even  if  slight,  is  more  important 
than  a  higher  temperature  for  a  short  period. 

The  pulse  and  breathing  are  difficult  to  count  in  infancy.  A 
mother  should  note  how  rapid  they  are  when  the  child  is  well  so 
that  in  case  of  illness  she  may  detect  any  difference. 

The  mother  should  also  observe  the  normal  position  of  the  child's 
body,  the  expression  of  his  face  and  his  color  so  that  indications  of 
discomfort,  pain,  or  unusual  irritability  can  be  quickly  noticed.  The 
character  and  number  of  bowel  movements  and  the  amount  and  color 
of  the  urine  should  be  watched.  The  mother  should  note  the  color 
of  the  tongue  and  throat  and  the  condition  of  the  skin. 

ESSENTIALS  IN  CARING  FOR  A  SICK  CHILD. 

A  young  child  who  has  any  rise  in  temperature  should  be  kept  in 
bed  in  a  cool,  quiet,  well-ventilated  room  and  should  be  allowed  to 
rest  or  sleep  undisturbed  as  much  as  possible.  A  fussy,  uncomfort- 
able baby,  or  a  child  showing  evidence  of  physical  discomfort  but 
without  fever,  should  be  treated  in  the  same  way. 

The  sick  room  should  not  be  a  gathering  place  for  the  family  or 
neighbors.  Even  if  no  contagious  disease  is  suspected  a  sick  child 
should  be  kept  away  from  other  children  until  the  trouble  is  known. 
This  one  precaution,  if  observed  faithfully,  would  do  much  to  stop 
the  spread  of  communicable  disease. 

The  doctor  should  be  promptly  notified  of  the  illness  of  a  baby, 
and  the  mother  should  keep  a  written  record  of  the  temperature,  rate 
and  regularity  of  the  pulse  and  respiration,  cough,  crying,  evidence 
of  pain,  and  general  appearance  of  the  child.  She  should  note  the 
amount  and  kind  of  food  taken,  amount  of  water,  number  and  char- 
acter of  stools,  amount  of  urine  passed,  vomiting,  or  any  unusual 
symptom.  A  specimen  of  the  stool  and  urine  should  be  saved  for  the 
doctor  to  see. 

When  orders  are  given  by  the  doctor,  they  should  be  carried  out 
carefully  and  exactly.  The  mother  should  put  down  daily  on  a  sheet 
of  paper,  or  a  chart,  the  hour  at  which  she  performed  each  detail, 
the  result,  and  any  unusual  symptom  noted. 

If  a  doctor  can  not  be  secured,  the  following  general  directions  for 
nursing  care  should  be  observed.  A  child  should  be  kept  in  bed  as 
long  as  he  has  a  temperature  over  99.5°  F.  If  his  illness  has  been 
at  all  severe,  he  should  stay  in  bed  from  three  days  to  one  week  after 
his  temperature  has  remained  normal  (98.6°  to  99.5°  F.)  for  24  hours. 
The  after  effects  of  many  diseases  may  be  largely  prevented  by  pro- 
longing this  care  during  convalescence. 

Frequent  changes  in  position  while  in  bed  are  important  not  only 
to  rest  the  child,  but  also  to  prevent  congestion  of  any  part  of  the 
body. 


INFANT   CARE.  81 

A  daily  sponge  or  tub  bath  should  be  given.  A  bath  for  fever 
(about  90°  F.)  may  be  given  once  or  twice  a  day  or  oftener,  if  the 
fever  is  high.  The  temperature  of  the  bath  should  be  tested  by  a 
thermometer.  Every  precaution  should  be  taken  in  bathing  a  sick 
child  not  to  chill  him  by  undue  exposure  nor  to  frighten  or  excite 
him.  A  cold  compress  or  ice  cap  may  be  kept  on  the  head  during 
fever,  while  bathing  to  reduce  the  temperature,  or  while  giving  a 
warm  pack.  If  the  hands  and  feet  are  cold,  hot  water  bottles  may 
be  used. 

The  food  should  be  reduced  in  every  acute  illness.24 

The  taking  of  water  is  of  the  greatest  importance  in  illness.  Water 
should  be  offered  at  very  frequent  intervals,  possibly  every  hour 
while  the  child  is  awake,  and  the  amount  taken  in  24  hours  should  be 
recorded. 

The  bowels  of  a  sick  child  should  be  moved  daily ;  if  necessary,  an 
injection,  or  enema,  of  warm  water  may  be  used  for  the  purpose. 
The  amount  of  the  urine  should  be  noted,  and  more  water  should  be 
given  to  drink  if  the  amount  of  urine  is  scant. 

Plenty  of  fresh  air  in  a  well-ventilated  room,  or  on  a  porch,  where 
the  sick  bed  may  be  placed  in  summer,  is  part  of  the  necessary  treat- 
ment in  any  sickness.  In  winter,  the  sick  room  may  be  kept  moder- 
ately warm  (60°-68°  F.)  in  the  daytime  while  the  child  is  awake, 
but  may  usually  be  kept  cooler  at  night,  or  when  the  child  is  asleep. 

A  child  that  has  been  trained  in  proper  health  habits  and  has  been 
accustomed  to  having  the  details  of  his  toilet  carefully  attended  to  is 
much  easier  to  take  care  of  in  sickness.  It  is  also  helpful  if  a  baby 
has  been  taught  to  show  his  tongue  and  throat  and  to  allow  himself 
to  be  handled.  A  child  should  never  be  frightened  by  threats  of 
punishment. 

The  comfort  and  happiness  of  the  baby  or  young  child  do  much  to 
shorten  recovery  from  sickness,  but  strict  discipline  must  be  main- 
tained as  to  nursing  care  and  the  carrying  out  of  the  doctor's  orders. 
The  way  a  child  is  managed  makes  the  greatest  difference  in  what 
can  be  done  for  him.  Even  a  young  baby  is  conscious  of  the  difference 
between  quiet,  skillful  handling  and  noisy  or  clumsy  treatment,  and 
responds  quickly  to  gentle,  restrained  methods. 

COMMON  DISORDERS  AND  DISEASES  OF  INFANCY. 

A  very  brief  description  of  the  most  common  disorders  and  in- 
fectious diseases  of  infancy  follows,  but  no  attempt  has  been  made 
to  give  a  detailed  account  of  their  cause,  nature,  or  treatment. 

24  See  p.    82. 

44527°— 21 6 


82  INFANT  CAEE. 

Sudden  illness. 

In  any  slight  indisposition  with  fever,  such  as  a  bad  cold,  the  food 
should  be  diluted  by  giving  less  whole  milk  and  more  water  in  the  24- 
hour  feeding.  Solid  food  should  be  omitted.  A  doctor  should  be 
called,  as  a  serious  development  may  follow  any  slight  illness  in  a 
young  child.  If  no  doctor  can  be  seen,  as  a  rule  it  is  wise  to  give  a 
child  sick  with  fever  an  enema. 

Vomiting. 

Vomiting  is  frequently  an  early  and  usual  symptom  of  overfeeding. 
Many  babies  spit  up  a  little  just  after  feeding,  especially  if  they  are 
handled  at  this  time.  In  reality,  this  is  a  "  spilling  over  "  which  may 
happen  to  any  baby  and  not  infrequently  it  is  caused  by  feeding  too 
often.  In  such  cases  lengthening  the  feeding  intervals  to  4  hours  is 
the  only  treatment  necessary. 

Too  much  food  may  cause  spitting  up,  and  the  amount  may  be 
decreased. 

The  food  may  be  taken  too  rapidly.  For  the  artificially  fed  baby 
the  holes  in  the  nipple  should  be  small  enough  to  prevent  this.  If 
breast-fed,  the  baby  should  be  removed  from  the  breast  for  short 
breathing  intervals.  Air  swallowed  while  nursing  may  cause  vomit- 
ing. To  remedy  this  the  baby  may  be  taken  up  and  held  against  the 
shoulder  until  the  air  is  expelled. 

For  repeated  vomiting,  a  physician  should  always  be  consulted. 

It  must  not  be  overlooked  that  vomiting  is  frequently  an  early 
symptom  in  infectious  diseases;  therefore,  when  vomiting  occurs  in 
a  well  baby  it  is  best  to  stop  the  food,  giving  only  boiled  water  until 
the  cause  is  determined. 

Hiccough. 

In  small  infants,  hiccough  is  not  infrequently  associated  with  over- 
filling the  stomach  with  food,  by  too  frequent  feeding  intervals,  or 
by  taking  the  food  too  rapidly.  It  usually  follows  eating,  and  may 
be  associated  with  air  or  gas  in  the  stomach.  Giving  the  baby  a  few 
spoonfuls  of  hot  water  usually  stops  it. 

Colic. 

Colic  is  due  to  the  pressure  of  gas  in  the  stomach  or  bowels.  In 
the  severe  forms  of  colic  the  diet  should  be  carefully  studied,  as  not 
infrequently  this  is  the  source  of  the  trouble.  The  treatment  of  the 
immediate  symptoms  consists  in  getting  rid  of  the  gas.  Holding  the 
baby  over  the  shoulder  with  a  bag  of  warm  water  pressed  against 
his  abdomen  or  gently  rubbing  the  abdomen  will  help  to  raise  the  gas. 
A  little  hot  water  and  a  pinch  of  soda  bicarbonate  may  help.  One 
or  two  small  injections  cf  warm  water  in  the  rectum  by  means  of  a 


INFANT  CAKE.  83 

small  bulb  syringe  may  give  relief.    The  baby  should  be  kept  warm, 
especially  the  hands  and  feet. 

Constipation. 

Constipation  may  occur  in  both  breast-  and  bottle-fed  babies.  It 
is  due  to  a  variety  of  causes,  but  can  usually  be  overcome  by  training 
and  change  in  diet  without  the  use  of  drugs.  The  correction  of  this 
condition  often  requires  the  treatment  of  constipation  in  the  mother.25 

Training  to  establish  the  habit  of  a  regular  daily  bowel  movement 
can  not  be  begun  too  nearly  in  infancy.  Many  mothers  have  this 
regulated  after  the  second  month,  and  it  is  a  most  important  measure 
in  the  prevention  of  constipation.26  Constipation  is  also  helped  by 
plenty  of  water.  The  older  the  baby,  the  more  important  it  is  that 
he  should  drink  water,  or  take  it  from  a  nursing  bottle.  Water 
should  be  oifered  to  a  young  infant  at  least  once  or  twice  a  day,  a 
few  ounces  at  a  time;  a  year-old  baby  should  take  6  to  8  ounces  a 
day.     Drinking  water  should  be  boiled  and  cooled. 

Fruit  juice,  such  as  orange  juice  and  prune  juice,  will  help  very 
much  in  making  a  soft  movement.  Cereals,  especially  oatmeal  and 
graham  gruel,27  vegetable  and  fruit  pulp  are  also  laxative. 

If  an  infant  does  not  have  a  movement  for  48  hours  it  may  be 
necessary  to  resort  to  temporary  measures  for  relief. 

Massaging  the  abdomen  gently  with  a  rotary  movement  just  be- 
fore the  time  for  a  bowel  movement  may  be  beneficial. 

A  simple  and  effective  massage  for  emptying  the  lower  part  of 
the  large  intestine  is  carried  out  as  follows : 

Place  the  balls  of  the  fingers  in  the  lower  left-hand  portion  of 
the  abdomen  moving  them  upward  by  a  series  of  circular  movements 
to  above  the  navel  on  the  left  side,  then  carry  the  movements  across 
the  abdomen  just  above  the  navel  to  the  right  side  and  end  by  pass- 
ing down  on  the  right-hand  side  and  over  to  the  middle  line  low 
down.  (This  movement  is  used  for  emptying  the  lower  part  of  the 
large  bowel;  for  massage  of  the  first  part  of  the  large  bowel  the 
movements  are  in  the  opposite  direction.) 

Soap  or  other  suppositories  26  may  be  used  instead  of  an  enema. 
Neither  enemas  nor  suppositories  should  be  used  over  long  periods 
of  time,  as  irritation  of  the  rectum  may  result. 

An  enema  or  injection  may  be  given.  For  this  purpose  prepare 
warm  soapy  water,  using  a  mild  white  or  Castile  soap  and  a  bulb 
syringe  holding  from  1  to  3  ounces.  To  fill,  squeeze  the  bulb,  while 
holding  the  nozzle  under  water;  when  the  bulb  is  released  it  will 
fill  with  water  by  suction.     Let  the  baby  lie  on  his  back  across  the 

25  See  p.  49.  26  See  p.  42.  *  See  p.  99. 


84  INFANT   CAKE. 

mother's  lap,  or  on  a  table,  having  the  buttocks  somewhat  elevated 
by  means  of  a  folded  towel  placed  under  the  hips.  This  position  will 
cause  the  water  to  run  up  into  the  bowel  more  readily  and  the  towel 
will  serve  to  catch  any  drip.  Grease  the  nozzle  of  the  syringe  with 
vaseline.  Lift  the  baby's  legs  with  the  left  hand  and  with  the  right 
introduce  the  nozzle  into  the  rectum  for  about  1  inch,  directing  it 
toward  the  back,  and  slowly  expel  the  water  from  the  bulb.  This 
causes  the  baby  little  or  no  suffering  if  gently  and  slowly  done, 
although  if  he  is  badly  constipated  the  starting  of  the  movement  may 
be  somewhat  painful.  When  the  liquid  has  been  injected,  remove  the 
nozzle  and  press  the  towel  against  the  opening  of  the  bowel  to  retain 
the  water  until  the  baby  can  be  placed  over  the  chamber.  As  the 
water  sometimes  comes  away  as  the  nozzle  is  withdrawn,  the  mother's 
clothing  should  be  well  protected.  Use  2  or  3  ounces  of  warm,  soapy 
water,  and  repeat,  if  necessary. 

If  the  constipation  is  especially  severe,  1  to  2  tablespoonfuls  of 
warm  olive  or  sweet  oil  may  be  used  instead  of  the  soapsuds.  This 
may  be  given  at  night  and  retained. 

Mineral  oil,  which  is  not  absorbed  but  which  acts  as  a  lubricant  of 
the  bowel,  may  be  given  safely  to  young  infants  in  a  teaspoonful 
dosage  once  or  twice  a  day.  Milk  of  magnesia,  one-half  to  2  teaspoon- 
fuls,  may  be  given  if  preferred  until  the  constipation  is  regulated. 
The  magnesia  may  be  put  in  the  bottle  feeding  or  given  from  a  tea- 
spoon just  before  the  breast  or  bottle  feeding.  Castor  oil  should  not 
ordinarily  be  used  as  a  laxative,  as  its  after  effect  is  constipating. 

Diarrhea. 

Although  serious  attacks  of  diarrhea  and  dysentery  may  occur  in 
any  season,  they  are  much  more  common  in  warm  weather.  Breast 
feeding,  good  hygienic  surroundings,  pure  milk  supply,  and  knowl- 
edge of  the  proper  methods  of  artificial  feeding  and  the  care  of  young 
children  are  the  effective  means  of  preventing  this  condition. 

Whenever  a  young  child  has  watery  stools,  or  mucus  and  blood 
in  his  stools,  a  physician  should  be  called  at  once.  No  food  should 
be  given  until  his  arrival.  Boiled  water  should  be  given  frequently 
but  in  moderate  quantities.  The  rapid  loss  in  weight,  which  is  a 
marked  feature  of  the  disease,  is  largely  due  to  loss  of  water,  and 
therefore  the  giving  of  water  is  necessary  to  replace  this  loss. 

A  slight  diarrhea  or  a  number  of  loose,  undigested  stools  in  the 
artificially- fed  baby  who  is  doing  well  calls  for  an  immediate  reduc- 
tion in  the  food.  A  safe  rule  is  to  dilute  the  food  by  pouring  out 
half  the  next  bottle  and  filling  it  with  boiled  water,  or,  if  the  food  is 
not  made  up,  by  taking  only  half  as  much  milk  and  sugar  as  have 


INFANT    CARE.  85 

been  given,  and  making  up  the  total  with  boiled  water  or  cereal 
water.    The  doctor  should  be  notified. 

If  no  physician  is  available,  and  if  the  loose  movements  continue, 
one  small  dose  of  castor  oil,  1  or  2  teaspoonfuls,  should  be  given  and 
the  baby  allowed  no  milk  for  24  hours.  Boiled  water  or  cereal  water 
should  be  offered  at  frequent  intervals.  This  is  usually  sufficient  for 
simple  diarrhea.  The  return  to  milk  should  be  made  gradually,  and 
at  first  the  milk  should  be  skimmed  and  boiled  for  five  minutes. 
The  mixture  should  be  started  at  one-half  the  previous  strength. 

Overfeeding  may  cause  diarrhea,  and  is  remedied  by  lengthening 
the  interval  or  reducing  the  strength  of  the  mixture. 

Where  spoiled  food  is  suspected  as  a  cause,  a  single  dose  of  1  or  2 
teaspoonfuls  of  castor  oil  may  be  given.  Diarrhea  should  always  be 
considered  a  serious  condition  in  bottle-fed  babies,  and  should  there- 
fore be  treated  by  a  doctor. 

Milk  from  cows  fed  from  fresh  ensilage  or  alfalfa  hay,  etc.,  may 
cause  sudden  diarrhea  in  infants  and  small  children. 

Hot-weather  disturbances. 

Digestive  upsets  are  more  frequent  in  hot  weather  than  at  any 
other  time.  Milk  is  more  easily  contaminated  when  the  temperature 
is  high  and  when  flies  abound. 

In  hot  weather  every  effort  should  be  made  to  keep  the  baby  in  a 
cool  place,  to  keep  him  lightly  clad,  to  give  him  frequent  sponge 
baths,  and  to  have  him  drink  an  abundance  of  cool,  boiled  water. 

The  value  of  breast-feeding  is  at  no  time  more  clearly  demon- 
strated than  in  the  summer  months.  Digestive  upsets,  diarrheal  dis- 
eases, and  deaths  from  such  disorders  at  this  season  are  relatively  in- 
frequent in  babies  fortunate  enough  to  have  mother's  milk.  In  hot 
weather  all  cow's  milk  should  be  scalded  and  should  be  handled  toith 
special  care.28 

An  infant  should  not  be  urged  to  finish  his  bottle  or  to  eat  if  he  is 
not  hungry.  During  short  periods  of  excessive  heat,  the  amount  of 
milk  given  in  the  24  hours  should  be  reduced. 

Scurvy. 

Scurvy  is  a  disease  caused  by  a  lack  of  certain  elements  in  the 
food.  The  condition  is  rare  in  breast-fed  babies  or  those  fed  on  raw 
milk,  but  is  found  chiefly  in  artificially- fed  babies  who  have  lived  for 
long  periods  on  sterilize'd  or  proprietary  foods.  Scurvy  may  be  pre- 
vented and  cured  by  the  feeding  of  fresh  fruit  and  vegetable  juices 
in  addition  to  the  milk. 

Rickets. 

Rickets  is  a  disease  of  nutrition  in  which  the  bones  are  the  parts 
most  affected.     The  bones  become  softer  than  normal.     Bowlegs, 


28  See  p.   63. 


86  INFANT    CARE. 

knock-knees,    flat-foot,    and    chest    deformities    frequently    result. 
Sweating  of  the  head  and  restlessness  are  common  in  rickets. 

The  treatment  consists  in  proper  feeding  and  in  good  hygienic 
conditions.  Bad  living  conditions  and  lack  of  fresh  air  always 
aggravate  the  disease. 

Heat  rash. 

This  rash  may  appear  either  in  summer  or  in  winter;  it  is  asso- 
ciated with  unusual  perspiration,  or  the  irritation  of  wool  next  to  a 
sensitive  skin.  A  rash  of  fine  red  spots  usually  comes  out  first  on  the 
neck  or  chest.  Lighter  clothing  should  be  substituted  and  soft  mus- 
lin or  linen  placed  next  to  the  skin.  The  body  or  the  parts  affected 
should  be  sponged  frequently,  or  dabbed  with  bicarbonate  of  soda 
and  water,  or  powdered  with  starch  and  boric-acid  powder  (2  parts 
of  starch  to  1  part  of  boric  acid). 

Chafing. 

Chafing  is  a  redness  or  irritation  of  the  skin  appearing  usually  in 
the  folds  of  the  skin  or  on  surfaces  that  rub  or  touch.  It  is  frequently 
found  in  fat  babies.  Chafing  may  also  occur  on  the  buttocks  if  wet 
diapers  are  not  changed  frequently  enough,  if  the  skin  is  not  care- 
fully cleaned  and  dried  after  a  bowel  movement,  or  if  the  soap  has 
not  been  carefully  rinsed  out  of  the  diapers. 

Cleanliness  is,  therefore,  of  primary  importance  in  preventing  this 
condition. 

A  dusting  powder  of  boric  acid  and  starch  or  cold  cooked  starch 
paste  may  be  freely  used  on  the  chafed  skin  and  pieces  of  soft  linen 
may  protect  the  sensitive  surfaces.  Little  or  no  soap  should  be  used. 
Bran  29  may  be  put  into  the  water  used  for  bathing,  or  oil  instead  of 
water  may  be  used  for  cleaning  the  irritated  skin. 
Eczema. 

A  variety  of  skin  disorders,  common  in  infancy,  are  grouped  under 
this  general  name.  Certain  children  show  a  tendency  to  eczema  from 
birth.  Any  irritation,  caused  by  tight  clothing,  dirt,  mucous  dis- 
charges, or  strong  soap,  may  cause  redness  or  an  eruption  which  may 
be  either  oozing  moisture  or  covered  with  crusts.  By  removing  the 
local  irritation  the  skin  trouble  may  be  entirely  cured.  Eczema  may 
come  and  go,  but  it  is  always  increased  by  uncleanliness  and  un- 
hygienic living  conditions. 

Eczema  may  occur  in  both  breast-  and  bottle-fed  babies.  These 
children  may  be  small  and  delicate  from  birth,  but  most  frequently 
large,  fat  babies  are  the  ones  affected  by  this  disease.  Eczema  seems 
to  bear  a  definite  relation  to  overfeeding,  especially  with  mixtures 
containing  too  much  fat. 

20  See  p.  26,  Bran  bath. 


INFANT    CARE.  87 

If  a  breast-fed  baby  has  eczema,  do  not  wean  him,  but  give  him  a 
little  warm  water  just  before  nursing  and  lengthen  the  interval 
between  feeding  and  shorten  the  nursing  period. 

Bathing  with  soap  should  be  given  up  entirely,  and  the  use  of 
water  has  to  be  omitted  in  severe  cases,  cleaning  the  skin  with  oil 
instead.    Bran  baths  are  very  soothing.30 

The  diet  and  local  treatment  should  always  be  directed  by  a  phy- 
sician, as  children  with  eczema  have  to  be  carefully  treated  for  a  long 
time. 

Scratching  must  be  prevented  and  usually  some  restraint  of  the 
hands  is  necessary  to  accomplish  this.  A  starched  cuff  or  tube  made 
of  cardboard  or  other  stiff  material  to  prevent  bending  the  elbows 
may  be  fastened  in  the  sleeves  which  are  pinned  to  the  sides  to  pre- 
vent the  hands  from  reaching  the .  face.  White  mittens  or  stockings 
on  the  hands  may  also  be  found  useful. 

Thrush. 

The  inside  of  the  cheeks  and  less  frequently  the  lips  and  tongue 
may  be  covered  with  small  white  spots,  which  may  be  run  together 
and  cover  the  whole  inside  of  the  mouth  and  even  continue  down 
into  the  throat.  The  mouth  in  this  condition  should  be  washed  be- 
fore and  after  each  feeding,  or  even  every  hour  while  the  baby  is 
awake,  with  bicarbonate  of  soda  and  water  (1  level  teaspoonful  to 
3  ounces  of  boiled  water).  Great  care  should  be  taken  not  to  hurt 
the  mucous  membrane.  If  the  mucous  membrane  is  irritated  by  rub- 
bing when  swabbing  the  mouth  it  will  aggravate  the  condition. 
Great  precaution  should  be  taken  to  sterilize  everything  put  into  the 
baby's  mouth,  for  thrush  is  due  to  a  mold.  It  follows  a  lack  of  clean- 
liness in  care  of  artificial  nipples  or  use  of  dirty  "  pacifiers."  Care- 
lessness will  lead  to  infection  of  other  infants. 

Convulsions. 

Convulsions  always  terrify  mothers,  but  fortunately  are  not  usually 
serious.  Most  convulsions  are  not  due  to  disease  of  the  brain  or 
nervous  system,  but  are  caused  by  undigested  food  in  the  stomach 
or  bowels,  or  from  the  absorption  of  poisons  from  the  intestinal  tract. 
Convulsions  appear  most  often  in  early  childhood  and  in  children 
suffering  from  nutritional  disorders.  They  are  also  frequent  at  the 
beginning  of  acute  infectious  diseases.  As  the  condition  may  be 
serious  a  physician  should  always  be  sent  for.  While  waiting  for 
him  to  arrive  the  baby  should  be  undressed  and  put  into  a  bathtub 
of  warm  water.  Great  precaution  should  be  taken,  however,  not  to 
have  the  bath  too  hot.  Many  babies  have  been  seriously  burned  be- 
cause the  mother,  in  her  excitement,  used  too  hot  water  for  the  bath. 
The  temperature  of  the  water  should  be  taken  with  a  bath  ther- 

30  See  p.  26,  Bran  bath. 


88  INFANT   CASE. 

mometer,  and  should  not  be  over  105°  F.,  or,  if  tested  only  by  feeling, 
the  elbow  should  be  used  for  the  purpose,  as  it  is  more  sensitive  than 
the  hand.  An  ice  cap  or  cold  cloth  should  be  kept  on  the  baby's 
head.  The  child  should  be  disturbed  as  little  as  possible,  and  should 
be  put  to  bed  when  the  twitching  subsides. 

If  the  doctor  does  not  come,  the  baby  should  be  given  an  enema 
and  the  bowels  thoroughly  evacuated.  The  enema  should  be  repeated 
until  the  bowels  are  emptied.  If  it  is  known  that  the  child  has  been 
eating  unwisely,  a  dose  of  castor  oil  (from  1  to  3  tea  spoonfuls)  may 
be  given.  A  child  should  stay  quietly  in  bed  for  several  days  after 
a  seizure  of  this  kind ;  he  should  be  given  nothing  but  water  for  the 
first  24  hours,  and  should  have  his  iood  considerably  reduced  for 
several  days. 

Worms. 

Pinworm  is  practically  the  only  worm  common  in  infancy.  When 
it  is  present,  examination  of  a  stool  recently  passed  will  reveal  tiny 
threadlike  worms  less  than  half  an  inch  in  length.  No  treatment 
should  be  started  unless  the  worms  can  be  detected  and  can  be  seen 
in  motion.  As  pinworms  inhabit  the  lower  bowel,  as  a  rule  only 
rectal  treatment  is  needed,  and  this  is  fairly  simple  under  a  phy- 
sician's directions.  Scrupulous  cleanliness  must  be  observed,  in  order 
not  to  infect  other  members  of  the  family,  or  to  reinfect  the  child. 
Worm  medicines  are  not  to  be  taken  except  on  the  advice  of  the 
physician. 

Colds. 

Babies  are  frequently  the  victims  of  cold  in  the  head,  because  of 
their  thoughtless  exposure  to  some  one  suffering  from  this  complaint. 
All  colds  are  contagious  and  isolation  of  the  baby  from  them  is  neces- 
sary if  spreading  is  to  be  prevented.  Infection  is  usually  contracted 
from  the  sneezing  or  coughing  of  some  careless  person  or  by  unclean 
hands  and  handkerchiefs.  Too  warm  living  or  sleeping  rooms,  too 
heavy  clothing,  too  little  outdoor  air,  or  exposure  and  chilling,  or 
enlarged  adenoids  help  to  make  young  children  susceptible.  Since 
many  of  the  contagious  diseases  begin  with  sore  throat  or  a  running 
nose  it  is  important  to  isolate  all  babies  with  colds. 

If  the  mother  has  a  cold  she  should  make  every  effort  to  protect 
her  baby  from  taking  the  cold  from  her.  She  should  wash  her  hands 
thoroughly  before  handling  the  baby  or  preparing  his  food.  If  she 
is  nursing  the  baby  she  should  cover  her  mouth  and  nose  with  four 
thicknesses  of  cheesecloth  or  surgical  gauze  while  the  baby  is  at  the 
breast  or  while  she  is  bending  over  and  caring  for  him. 

Colds  in  the  head  cause  difficulty  in  breathing.  Two  or  three  drops 
of  liquid  vaseline  in  the  nose  three  or  four  time  a  day  help  to  keep 
the  passages  clear  and  make  breathing  easier.     Rest  in  bed  is  an 


INFANT    CARE.  89 

essential  part  of  the  treatment  of  every  bad  cold,  but  the  room  should 
be  well  ventilated  and  not  overheated. 

Adenoids. 

Enlarged  adenoids  may  occur  at  any  time  during  infancy  or  child- 
hood and  babies  are  even  born  suffering  from  such  enlargement. 
Symptoms  of  the  blocking  of  the  nose  by  adenoids  are  disturbed 
sleep,  snoring,  sleeping  with  the  mouth  open,  and  inability  to  nurse 
for  any  length  of  time  without  having  to  stop  to  get  air  through  the 
mouth.  Repeated  head  colds,  chronic  discharges  from  the  nose, 
anemia,  and  malnutrition  may  result  from  adenoids.  The  serious 
effects  of  adenoid  enlargement,  such  as  mouth  breathing,  deafness, 
contracted  jaw,  and  interference  with  normal  growth  and  develop- 
ment, make  their  removal  necessary.  As  soon  as  a  child  shows  the 
symptoms  mentioned  above,  he  should  be  examined  by  a  physician  to 
detect  the  presence  of  adenoid  growths,  and  if  found,  they  should  be 
removed  as  soon  as  the  examining  physician  considers  it  desirable. 
If  adenoids  should  recur  and  again  cause  trouble  they  should  again 
be  removed. 

Enlarged  tonsils. 

This  disorder  may  also  occur  in  infants  from  the  same  causes  as 
adenoid  growths.  The  tonsils  should  be  called  to  the  attention  of  a 
physician,  and  they  should  be  removed  if  they  become  diseased  or  if 
their  enlargement  is  such  that  they  block  the  air  passages. 

In  general,  if  the  tonsils  are  not  a  menace  to  the  health  of  the 
child,  it  is  better  not  to  have  them  removed  during  infancy. 

Earache. 

Pain  in  the  ear  may  be  severe  and  is  often  indicated  by  screaming 
and  putting  the  hand  to  the  side  of  the  head.  Hot  compresses  or  a 
hot-water  bag  often  relieve  the  pain.  Nothing  should  be  put  in  the 
ear  except  under  a  doctor's  order,  as  more  harm  than  good  may 
result.  The  frequent  infection  of  the  ear  from  colds  or  adenoid 
growths  has  been  mentioned. 

Croup. 

Babies  and  young  children  not  infrequently  have  croup.  The 
attack  usually  comes  on  suddenly  at  night  when  the  baby  who  went 
to  bed  apparently  perfectly  well  wakes  up  with  harsh,  noisy  breath- 
ing, or  a  dry,  barking  cough,  and  some  difficulty  in  breathing.  The 
child  is  usually  frightened  and  his  fright  increases  the  symptoms. 
Croup  of  this  simple  or  catarrhal  nature  may  be  mistaken  for 
diphtheritic  or  membranous  croup,  which  is  a  most  dangerous 
disease.    The  symptoms  in  diphtheritic  croup  usually  do  not  develop 


90  INFANT    CARE. 

suddenly,  but  there  is  a  gradual  loss  of  voice,  and  the  symptoms  grow 
progressively  worse  and  do  not  yield  to  simple  measures  of  relief. 
Death  follows  diphtheritic  croup  from  obstructions  unless  anti- 
toxin is  given  early  and  the  child  is  under  constant  medical  super- 
vision. In  all  cases  of  croup  a  physician  should  be  consulted  and 
in  every  case  of  doubt  a  culture  should  be  made  to  ascertain  the 
presence  or  absence  of  diphtheria  germs. 

In  simple  croup  the  greatest  relief  is  obtained  by  keeping  a  tea- 
kettle boiling  in  the  room  near  the  child ;  a  tent  made  with  a  raised 
umbrella  and  a  sheet  thrown  over  it  is  placed  over  the  child;  and 
the  steam  from  the  kettle  is  introduced  under  the  tent  by  means  of 
a  long  horn  of  stiff  paper  fitted  into  the  spout  of  the  kettle.  This 
improvised  croup  kettle  should  be  kept  going  until  some  relief  is 
obtained.  Great  care  should  be  taken  to  prevent  scalding  the  baby. 
The  baby  should  not  be  left  alone  while  the  kettle  is  boiling.  Hot 
or  cold  compresses  over  the  throat  may  also  be  helpful.  If  the  child's 
breathing  becomes  too  difficult  vomiting  should  be  induced  by  giving 
a  half  teaspoonful  of  sirup  of  ipecac,  which  may  be  repeated  in  15 
minutes  if  vomiting  has  not  occurred. 

The  day  after  the  attack  the  child  should  be  kept  quiet  and  in  bed, 
and  the  diet  should  be  very  simple  for  several  days.  The  air  in  the 
sleeping  room  of  a  child  having  croup  should  be  kept  warm  and 
fresh. 

ACCIDENTS. 

Swallowing  foreign  bodies. 

As  soon  as  the  infant  begins  to  creep  he  is  liable  to  pick  up  and 
swallow  anything  small  which  is  left  within  reach.  All  the  members 
of  the  family  must  constantly  keep  this  in  mind  and  not  leave  within 
reach  anything  that  the  baby  can  put  into  his  mouth.  Ordinarily 
such  objects  as  coins  and  pins  pass  through  the  intestines  without 
causing*  any  damage.  A  child  who  has  swallowed  any  article  should 
be  watched,  but  if  no  symptoms  develop  no  treatment  is  necessary. 
The  stools  should  be  examined  for  the  swallowed  article.  No  laxa- 
tive should  be  given. 

Swallowing  pills  or  poison. 

If  the  infant  has  swallowed  a  pill  or  possible  poison  he  should  be 
made  to  vomit  by  being  given  a  teaspoonful  of  sirup  of  ipecac  or 
warm  salt  water  in  large  quantity,  which  should  also  be  vomited. 
This  will  wash  out  the  stomach.  A  physician  should  be  called  ac 
once. 

Burns. 

Hot  liquids  or  hot  irons  should  not  be  left  within  reach  of  infants. 
While  holding  an  infant  one  should  not  handle  hot  dishes.     Open 


INFANT    CARE.  91 

fires  should  be  screened  so  securely  that  the  children  can  not  fall  in. 
In  case  of  burns  apply  oil  freely  and  cover  with  clean  cloths  soaked 
with  oil.    If  oil  is  not  at  hand  use  white  of  egg. 

Inhaling  foreign  substances. 

Children  are  frequently  given  a  box  of  talcum  powder  for  a  play- 
thing. This  is  unwise  if  the  box  contains  powder,  for  at  times  when 
the  baby  puts  the  box  in  the  mouth  the  cover  comes  off  and  the  pow- 
der is  drawn  in  through  the  nose  and  mouth  into  the  lungs,  and  fatal 
results  follow. 

COMMUNICABLE  DISEASES. 

A  certain  group  of  diseases  especially  common  in  early  childhood 
are  often  called  children's  diseases.  The  so-called  infectious  dis- 
eases include  "acute  eruptive  fevers"  (scarlet  fever,  measles,  Ger- 
man measles,  chicken  pox,  smallpox),  whooping  cough,  mumps, 
diphtheria,  infantile  paralysis,  and  cerebrospinal  meningitis.  These 
diseases  as  well  as  all  contagious  diseases  are  spread  from  person  to 
person,  largely  by  direct  contact  or  contact  with  the  excretions  or 
secretions  from  the  person  suffering  with  the  disease.  This  means 
that  contagious  disease  is  carried  because  some  one  was  ignorant  or 
careless  enough  not  to  prevent  its  spread. 

The  younger  the  baby  the  more  serious  is  the  disease  apt  to  be ; 
therefore  every  effort  should  be  made  to  keep  a  baby  from  getting 
any  of  these  diseases.  Any  child  suffering  with  a  contagious  disease 
should  be  kept  on  his  own  premises,  or  at  least  away  from  other 
children,  as  long  as  there  is  any  possibility  of  his  giving  the  disease. 
In  most  States  this  quarantine  or  isolation  of  disease  is  compulsory 
by  law  for  at  least  those  diseases  considered  most  dangerous.  Chil- 
dren may  have  a  second  attack  of  any  one  of  these  diseases,  but  this 
is  rare  and  not  the  rule.  It  is  wise  to  employ  a  physician  even  in 
mild  cases. 

Every  effort  should  be  made  to  prevent  infection  and  spread  to 
other  members  of  the  household,  especially  other  children.  Parents 
must  realize  that  they  have  a  responsibility  to  the  community  as 
well  as  to  the  patient. 

How  to  prevent  the  spread  of  children's  diseases. 

Disease  germs  are  found  chiefly  in  discharges  from  the  sick  person's 
nose,  throat,  mouth,  eyes,  or  ears.  By  contact  with  these  discharges 
contagious  diseases  may  be  communicated  to  well  persons.  When  a 
patient  coughs  or  sneezes  many  droplets  laden  with  disease  germs  are 
forced  into  the  air.  Handkerchiefs,  towels,  dishes,  or  any  articles 
which  have  been  near  the  patient  may  be  contaminated  by  these 
poisons. 


92  INFANT    CARE. 

In  order  to  prevent  the  spread  of  disease  these  discharges  should 
be  destroyed  as  soon  as  they  leave  the  body.  Certain  general  direc- 
tions follow: 

The  sick  room. 

Choose  a  room  that  is  sunny,  well- ventilated,  and  screened.  It  is 
an  advantage  to  have  it  near  the  bathroom.  Remove  carpets,  rugs, 
upholstered  furniture,  and  hangings.  Leave  in  it  only  such  necessary 
furniture  as  can  be  washed  and  such  toys  and  books  as  can  be  de- 
stroyed. Have  plently  of  hot  water  easily  available.  Provide  clean 
old  muslin,  absorbent  cotton,  or  paper  napkins  to  be  used  instead 
of  handkerchiefs,  and  paper  bags  into  which  these  can  be  dropped. 
Have  a  generous  supply  of  bed  linen.  Dusting  should  be  done  with 
a  damp  cloth.  A  large  covered  slop  jar  may  be  used  in  the  room 
unless  there  is  a  toilet  close  by  which  can  be  devoted  to  the  sole  use 
of  the  patient. 

The  nurse. 

When  in  the  sick  room  the  nurse  should  wear  a  washable  cap  and 
a  cover-all  apron  or  gown.  When  she  leaves  the  room  she  should 
remove  cap  and  gown,  wash  her  face  and  scrub  her  hands  thoroughly 
in  soap  and  water.  She  may  use  rubber  gloves,  especially  if  there  is 
a  discharging  wound  to  be  dressed.  The  nurse  should  never  eat  in 
the  sick  room.  A  cap  and  gown  should  be  kept  for  the  physician's 
special  use. 

The  patient. 

Take  special  care  of  everything  which  comes  in  contact  with  the 
patient. 

The  outer  clothing,  worn  when  he  was  taken  ill,  should  be  brushed 
in  the  open  air  and  exposed  to  the  sunlight  for  at  least  one  day. 
Towels,  bed  linen,  and  washable  clothing  should  be  boiled  for  10 
minutes  in  soapsuds  before  going  to  the  general  wash.  All  dishes 
should  be  boiled  in  soapsuds  after  use,  and  kept  separate  for  the 
patient.  Remnants  of  food  should  be  burned.  Sputum  and  dis- 
charges from  the  eyes,  ears,  nose,  and  throat,  or  wounds,  should  be 
received  in  clean  muslin  or  absorbent  cotton  or  paper  napkins.  These 
should  be  dropped  in  paper  bags  and  later  burned  without  opening 
the  bags. 

At  the  end  of  quarantine  the  patient  should  have  a  thorough  bath 
and  shampoo.  The  mouth  should  be  carefully  cleansed,  and  he 
should  be  dressed  in  entirely  clean  clothing  in  an  adjoining  room. 

Disinfecting  the  sick  room. 

After  the  illness,  clean  the  room  thoroughly.  Scrub  the  floor, 
woodwork,  and  furniture  with  soap  and  hot  water.    Wipe  the  walls 


INFANT   CARE.  93 

with  cloths  wrung  from  a  1-1000  bichloride 31  solution  and  leave  the 
windows  wide  open.  If  the  illness  is  scarlet  fever,  diphtheria,  or 
smallpox,  repapering  and  painting  are  desirable.  Destroy  toys  and 
books;  boil  in  soapsuds  all  washable  bedding;  send  mattress  and 
unwashable  bedding  to  a  steam  disinfecting  place  if  possible,  or  ex- 
pose to  sunlight  for  two  or  three  days  and  beat  thoroughly  in  the 
open  air. 

If  the  bathroom  or  any  other  room  has  been  used  by  the  nurse,  it 
should  be  cleaned  in  the  same  way. 

Air  fumigation  has  been  found  to  be  of  little  value.  Scrubbing 
with  soap  and  water  and  exposure  to  sunshine  are  the  best  disin- 
fectants. 

Whooping  cough. 

This  disease  is  one  of  the  most  serious  in  early  infancy  and  every 
means  should  be  employed  to  prevent  a  child  from  contracting  it. 
It  usually  begins  as  a  cough  without  fever,  and  the  whoop  does  not 
develop  until  the  cough  has  been  present  for  about  two  weeks,  or 
sometimes  even  longer.  Vomiting  frequently  follows  a  severe  spell 
of  coughing. 

When  there  is  an  epidemic  or  a  suspicion  of  whooping  cough  every 
child  with  a  cough  should  be  considered  suspicious  and  should  be 
kept  away  from  other  children  until  the  diagnosis  has  been  estab- 
lished. This  is  one  of  the  few  diseases  where  a  child  need  not  go  to 
bed  (unless  he  has  fever) ,  but  he  should  be  restrained  from  violent  ex- 
ercise or  exertion. 

Frequent  feeding  to  prevent  excessive  loss  in  weight  and  lowered 
resistance,  may  be  necessary  if  vomiting  persists. 

Plenty  of  fresh  clothing  and  bedding,  frequent  but  careful  bath- 
ing, and  prompt  burning  of  the  expectorations  help  prevent  the 
spread  of  the  disease.  The  sleeping  and  living  rooms  should  be  well 
ventilated  and,  if  the  weather  permits,  the  more  a  child  can  be  out 
of  doors,  the  better,  but  he  should  be  isolated  from  other  children. 
The  child  can  probably  give  the  disease  for  at  least  six  weeks  from 
the  time  of  infection. 

Measles. 

Usually  about  14  days  after  exposure  an$  after  3  or  4  days  of 
symptoms  of  cold  in  the  head,  running  nose  and  eyes,  with  fever,  an 
eruption  appears  on  the  inside  of  the  mouth  and  on  the  skin.  The 
skin  rash  begins  with  small,  dark-red  spots  on  the  face  and  within 
2  or  3  days  spreads  over  the  body.  It  fades  during  the  week,  leaving 
a   fine   branlike   scaling   which   often   goes   unnoticed.     The    child 

81  Directions  for  making  the  solution  will  be  found  on  the  label  of  the  box  of  bichloride 
tablets,  which  may  be  purchased  from  any  drug  store. 


94  INFANT   CARE. 

should  stay  in  bed  and  be  kept  warm  at  least  a  week.  The  eyes,  if 
sensitive,  should  be  protected  from  strong  light.  The  room  should 
be  well  ventilated  but  moderately  warm.  Measles  is  most  contagious 
in  the  early  stages  before  the  rash  appears,  but  may  be  given  for  at 
least  one  week  or  much  longer  if  there  is  a  discharge  from  the  nose 
or  ears. 

German  measles. 

This  is  a  different  disease  from  measles.  Often  there  is  little  fever 
and  catarrhal  symptoms  are  absent  (cold  in  head,  running  nose  and 
eyes)  so  that  the  disease  begins  suddenly,  usually  14  days  after 
exposure,  with  a  rash  which  spreads  rapidly  and  lasts  a  few  days. 
Frequently  the  glands  in  the  back  of  the  neck  are  enlarged.  Without 
complications,  recovery  is  rapid.     Isolation  for  two  weeks  is  sufficient. 

Scarlet  fever. 

Usually  from  2  to  5  days  after  exposure,-  this  disease  starts  with 
fever  commonly  accompanied  by  vomiting  and  sore  throat.  The 
whole  throat,  as  a  rule,  is  very  red.  A  bluish  red  rash  appears  first  on 
the  neck  and  chest  on  the  first  or  second  day,  gradually  extends  over 
the  entire  body,  and  disappears  by  the  eighth  day.  A  characteristic  of 
the  disease  is  the  peeling  of  the  skin  following  the  disappearance  of 
the  rash.  On  the  trunk  the  skin  peels  in  fine  branlike  flakes  and  the 
peeling  is  completed  in  from  one  to  three  weeks.  Peeling  continues 
longer  where  the  skin  is  the  thickest,  the  palms  of  the  hands  and  the 
soles  of  the  feet,  and  lasts  four  weeks  and  frequently  six  or  eight 
weeks.  Peeling  here  is  in  large  patches  or  casts.  In  very  mild  cases 
where  the  rash  has  not  been  observed  this  characteristic  peeling  of 
hands  and  feet  may  be  the  only  means  of  making  a  diagnosis,  but 
in  some  cases  there  may  be  no  peeling. 

The  child  must  be  kept  in  bed  for  three  weeks,  even  if  no  active 
symptoms  persist,  for  the  poisons  which  develop  in  the  disease  may 
cause  serious  and  lasting  injury. 

Complications  involving  the  heart,  kidneys,  glands,  and  ears  are 
frequent  and  serious.  Frequent  examination  of  the  urine  is 
important. 

The  outcome  of  this  disease  is  particularly  influenced  by  the  care 
given  the  patient.  Chilling  should  be  carefully  guarded  against. 
Fresh  air  and  warm  sponge  baths,  however,  are  beneficial,  if  prop- 
erly given.  It  is  important  that  plenty  of  water  should  be  given. 
The  diet  at  the  beginning  should  be  limited  to  milk,  cooked  cereals, 
and  fruit  juices. 

All  cases  of  scarlet  fever  should  be  considered  contagious,  and  the 
patient  isolated  for  at  least  four  weeks  and  longer  if  the  discharges 
from  the  mucous  membranes  still  persist.  Scarlet  fever  may  be 
carried  in  milk. 


INFANT   CARE.  95 

Chicken  pox. 

About  14  to  21  days  after  exposure  an  eruption  breaks  out  first  on 
the  face  and  chest.  Some  fever  usually  accompanies  or  precedes  the 
rash.  The  rash  first  appears  as  raised  red  spots,  then  as  water  blis- 
ters, then  scales  or  crusts.  There  may  be  few  or  many  of  these  blisters, 
and  fresh  ones  may  appear  while  others  are  drying.  It  is  important 
that  the  child  should  not  scratch  and  infect  the  blisters.  Powder  or 
bicarbonate  of  soda  solution  32  may  be  used  for  early  itching  and 
carbolized  vaseline  ointment  to  soften  the  crusts.  There  are  usually 
no  severe  general  symptoms  or  complications.  The  child  should  be 
kept  in  bed  for  three  days  or  until  no  fresh  spots  appear. 

The  disease  is  probably  infectious  as  long  as  the  eruption  is  pres- 
ent.   The  child  should  be  isolated  as  long  as  the  crusts  are  present. 

Smallpox. 

This  disease  would  be  unknown  if  the  Nation  would  avail  itself  of 
vaccination.  This  protection  may  last  for  years  and  in  those  cases 
where  the  disease  is  contracted  after  vaccination  by  those  who  may 
have  lost  part  of  their  immunity,  due  to  the  lapse  of  years,  the  dis- 
ease is  usually  very  mild  and  results  in  slight  scarring. 

Children  should  be  vaccinated  against  smallpox  before  they  are  1 
year  old  and  then  every  7  years  while  in  school.  If  a  baby  has  a  skin 
disease  it  may  be  necessary  to  defer  this  temporarily. 

Vaccination  is  absolutely  harmless  if  done  properly  with  good 
vaccine  and  the  wound  carefully  protected  from  infection. 

Diphtheria. 

This  disease  sometimes  occurs  in  infancy  but  is  most  common  in 
children  over  18  months  and  under  5  years  of  age.  It  begins  usually 
two  days  after  exposure  and  most  commonly  affects  the  nose  and 
throat.  Gray  patches  on  the  tonsils,  soft  palate,  or  the  sides  of  the 
throat  should  suggest  diphtheria.  This  membrane  may  be  absent  or 
it  may  appear  in  the  larynx  (see  section  on  croup).  Swallowing  is 
usually  difficult  as  well  as  painful.  The  glands  of  the  neck  become 
swollen.  A  bloody  discharge  from  the  nose  is  characteristic  of  nasal 
diphtheria  and  should  always  lead  to  bacteriological  examination  for 
diphtheria.  The  child  usually  has  only  a  slight  fever  and  may  not 
appear  severely  ill,  which  adds  to  the  difficulty  of  diagnosis.  If 
antitoxin  is  given  early  and  in  sufficient  doses,  the  symptoms  usually 
improve  rapidly.  The  membrane  softens  and  loosens,  and  recovery 
begins.  Absolute  rest  for  three  or  four  weeks  is  necessary  to  avoid 
ill  effects  from  this  disease. 

No  more  serious  disease  than  diphtheria  exists,  and,  if  suspected,  a 
physician  must  be  obtained  if  possible,  for  early  antitoxin  treatment 

32  One  teaspoonful  soda  to  8  ounces  water. 


96 


INFANT    CARE. 


is  imperative  if  recovery  is  to  be  assured.  This  disease  is  quarantined 
until  all  symptoms  have  disappeared  and  negative  cultures  obtained 
from  the  throat  and  nose  of  the  patient.  This  is  one  of  the  diseases 
where  the  germs  can  be  carried  in  the  nose  or  throat  of  a  third  per- 
son who  is  himself  healthy,  and,  like  scarlet  fever,  it  is  not  in- 
frequently carried  in  milk. 

Unless  the  other  members  of  the  family  can  be  kept  under  careful 
supervision  antitoxin  should  be  given  to  them  to  prevent  their  con- 
tracting the  disease. 

Infantile  paralysis. 

Infantile  paralysis  usually  occurs  in  epidemics  in  the  warm  months, 
but  occasional  cases  may  occur  at  any  time,  It  usually  begins 
about  seven  or  eight  days  after  exposure  and  without  definite  symp- 
toms. There  may,  however,  be  fever,  vomiting,  slight  diarrhea,  or 
constipation,  general  weakness,  prostration,  irritability,  drowsiness, 
headache,  and  nervous  symptoms.  Often  muscular  weakness  or 
paralysis  in  the  neck,  back,  hands,  or  feet  is  the  first  thing  noticed. 
The  child  complains  of  pain  on  being  moved  and  stands  or  sits  with 
difficulty.  This  may  not  appear  until  the  third  or  fourth  day  of 
the  illness  or  even  later.  The  child  should  be  kept  in  bed,  usually 
for  three  or  four  weeks,  or  at  least  until  the  tenderness  disappears. 

After  the  tender  stage  is  past,  definite  treatment  to  reestablish 
muscle  power  and  to  correct  deformities  should  be  undertaken  in  a 
hospital  or  under  the  direction  of  a  specially  trained  person,  and 
should  be  persisted  in  for  at  least  two  years.  Quarantine  of  the 
patient  for  at  least  four  weeks  should  be  observed.  Children  under 
16  years  in  the  same  family,  or  who  have  been  exposed  to  the  disease, 
should  also  be  subject  to  quarantine.  The  cases  without  paralysis  and 
only  slight  symptoms  are  the  ones  most  likely  to  spread  the  disease. 
Therefore  all  exposed  children  should  be  quarantined. 

Summary  of  children's  communicable  diseases. 


Disease. 

Period  of 
incubation. 

Time  of 
eruption. 

Period  of  isolations 

Chicken  pox 

Diphtheria 

14-21  days 

2-7  days 

First  or  second 
day. 

Until  crusts  have  disappeared— usually  2  weeks. 
Until  cultures  are  negative — at  least  2  weeks. 

11-14  days 

10-21  days 

2-5  days 

Third  or  fourth 

day. 

First  day 

First    to    third 

day. 

During  period  of  discharges— usually  2  weeks. 

1  to  2  weeks. 

Until  all  discharges  have  ceased— usually  4  to  8 

German  measles . . 

Whooping  cough. 
Infantile  paralysis 

7-14  days 

2  days  to  2  weeks 

weeks. 
Until  spasmodic  cough  ceases — at  least  6  weeks. 

None 

4  to  8  weeks. 

«  Periods  of  isolation  vary  according  to  local  health  regulations. 

Note.— Average  figures  are  quoted  in  this  table,  but  there  may  be  wider  variations. 


INFANT   CAKE.  97 

Tuberculosis. 

This  disease  causes  so  large  a  number  of  deaths  during  infancy 
that  its  prevention  is  of  greatest  importance.  Babies  are  rarely  born 
with  tuberculosis,  though  babies  of  tuberculous  mothers  are  often 
weak  and  offer  little  resistance  to  the  infection.  Babies  acquire  the 
disease  from  contact  with  an  open  case  of  tuberculosis  or  through 
milk.38 

It  is  now  generally  believed  that  tuberculosis  which  develops  later 
in  life  may  be  the  result  of  a  tuberculous  infection  in  early  child- 
hood. A  tuberculous  mother  may  infect  her  child  directly  through 
droplets  of  sputum  and  for  this  reason  a  baby  should  not  live  in  the 
house  with  a  person  suffering  from  active  tuberculosis. 

Gonorrhea. 

Two  forms  of  gonorrhea  are  met  with  in  infancy,  ophthalmia  of  the 
newborn  (Baby's  Sore  Eyes)34  and  vaginitis. 

Girl  babies  are  not  infrequently  found  to  have  a  yellowish  white 
discharge  from  the  vagina.  In  many  cases,  this  discharge  is  that 
of  gonorrhea,  contracted  usually  from  some  member  of  the  house- 
hold who  is  suffering  from  the  disease.  The  germ  may  be  carried 
from  the  infected  person  to  the  baby  on  the  hands,  or  on  washcloths, 
towels,  or  diapers. 

In  caring  for  a  child  with  gonorrhea  the  mother  or  nurse  should 
scrub  her  hands  thoroughly  with  hot  water  and  soap  every  time  she 
handles  the  baby,  and  every  article  of  soiled  clothing  and  bedding 
used  for  the  baby  should  be  boiled  one-half  hour.  The  entire  bath 
equipment  should  be  strictly  separated.  The  baby  should  wear  a 
pad  to  catch  the  discharge,  and  these  pads  should  be  burned. 

Prompt  local  treatment,  under  the  direction  of  a  physician,  is 
necessary  to  cure  this  form  of  gonorrhea,  which  is  often  most  per- 
sistent and  difficult  to  stamp  out. 

Unless  the  utmost  precautions  are  taken,  this  disease  will  spread 
to  other  infants,  especially  girls,  who  may  come  in  contact  with  the 
sick  baby  or  the  person  caring  for  the  baby.  A  child  suffering  with 
the  disease  and  even  under  treatment  should  be  considered  as  a  pos- 
sible source  of  infection  for  as  long  as  there  is  a  discharge,  and  ever3' 
care  should  be  taken  to  prevent  the  spread  of  the  disease. 

Syphilis. 

Gonorrhea  and  syphilis  are  classed  together  as  "  venereal  dis- 
eases," against  which  the  whole  Nation  is  united  in  a  campaign  of 
prevention.     Syphilis,  unfortunately,  is  a  disease  which  is  common 


33  See  section  on  how  clean  cow's  milk  is  produced,  p.  65. 

34  See  Prenatal  Care,  p.  30. 

44527°— 21 7 


98  INFANT   GAEE. 

during  the  first  year  of  life.  Syphilis  is  one  of  the  principal  causes 
of  stillbirths.  Young  children  rarely  acquire  syphilis  after  birth. 
If  this  disease  is  known  to  have  been  contracted  by  the  parents, 
their  offspring  should  be  examined  by  a  physician  and  a  blood  test 
made  after  6  weeks  of  age.  A  blood  test  of  the  parents  should  also 
be  made.  Prompt  medical  treatment  may  save  the  baby  and  if  con- 
tinued will  usually  prevent  the  serious  later  developments  of  the 
disease.  Treatment  of  the  mother  while  she  is  pregnant  may  pre- 
vent the  disease  from  appearing  in  the  baby. 


FOOD  RECIPES.1 

BUTTERMILK  AND  WHEY. 
Buttermilk. 

Obtain  fresh  culture  of  lactic  acid  bacilli  at  drug  store.  Allow  milk 
to  stand  at  room  temperature  or  warm  slightly  to  about  80°  to  90°  F. 
Baw,  pasteurized,  or  boiled  milk  may  be  used,  either  whole  or 
skimmed.  Place  milk  in  earthenware  dish,  previously  scalded.  Stir 
in  culture,  cover,  and  allow  to  stand  in  a  warm  place  (about  80°  F.) 
until  the  curd  is  formed  (12-24  hours).  Beat  with  egg-beater  until 
the  curd  is  thoroughly  mixed.  Strain.  If  too  thick,  add  a  little 
water.  Save  about  4  ounces  to  use  as  culture  for  next  supply.  If 
buttermilk  is  made  daily,  a  new  culture  need  not  be  bought  oftener 
than  once  a  month. 

Whey. 

To  1  quart  whole  milk  warmed  to  100°  F.  add  one-half  ounce 
liquid  rennet,  stirring  for  a  moment  only.  After  standing  at  room 
temperature  until  thick  and  firm  (20-30  minutes)  pour  it  upon  a 
double  layer  of  gauze  and  draw  the  corners  together  to  make  a  bag. 
Allow  it  to  hang  for  an  hour  to  drain  off  the  whey.  Do  not  squeeze 
the  curd.    Keep  the  whey  on  ice  until  used. 

The  liquid  part  is  the  whey,  which  contains  most  of  the  sugar  and 
salts  of  the  milk,  the  soluble  protein  or  whey  protein,  and  nearly  one- 
third  of  the  fat.  The  composition  of  whey,  however,  depends  on 
both  the  way  it  is  made  and  whether  it  is  made  from  whole  or  skim 
milk.  Whey  that  is  pressed  from  the  curd  contains  a  large  and 
variable  amount  of  solids.  If  made  from  fat-free  milk,  whey  con- 
sists almost  entirely  of  sugar  and  salts,  while  whey  made  from 
whole  milk  may  contain  nearly  1  per  cent  protein  and  1  per  cent  fat. 

Whey  has  been  much  used  in  the  past  and  may  be  advantageously 
used  in  certain  types  of  indigestion.  However,  whey  used  as  the 
sole  food  is  inadequate  for  the  growth  needs  of  an  infant,  and  serious 
results  have  occurred  when  babies  have  been  put  on  this  diet  for 
some  acute  disturbance  and  have  been  kept  too  long  on  it. 

CEREALS. 
Cereal  water. 

Thin  gruel  or  cereal  water  is  usually  made  of  prepared  barley  or 
wheat  flour.  Take  from  1  to  2  level  tablespoonfuls  of  flour,  rub  to 
a  smooth  paste  with  a  little  cold  water,  then  stir  into  a  pint  of  briskly 

1  These  recipes  were  prepared  in  cooperation  with  the  Office  of  Home  Economics  of  the 
U.  S.  Department  of  Agriculture. 

99 


100  INFANT    CARE. 

boiling  water.  Stir  constantly.  After  the  mixture  has  boiled,  place 
it  in  a  double  boiler  and  cook  at  least  one-half  hour.  Do  not  salt 
for  a  baby  under  6  months  of  age.  Cereal  water  made  in  this 
way  should  not  need  straining.  If  it  has  lumped,  strain  through  a 
fine  wire  sieve. 

The  amount  of  flour  used  may  be  increased  from  1  to  5  level  table- 
spoonfuls  to  a  pint  of  water,  according  to  the  age  of  the  child.  If 
the  cereal  water  cooks  away,  the  content  may  be  made  up  to  1  pint 
by  adding  boiled  water.  If  oatmeal  or  any  other  cut  or  whole  grain 
is  used  to  make  cereal  water  for  young  infants,  it  should  be  cooked 
slowly  at  least  one  hour  and  strained  before  using. 

Gruels. 

Thick  cereal  water  is  often  called  gruel.  Grains,  such  as  pearl 
barley  or  oat  flakes,  in  the  proportion  of  from  2  to  4  tablespoonfuls 
to  the  pint  of  water,  may  be  used  instead  of  flour,  but  require  much 
longer  cooking.  Gruels  made  of  grains  should  be  strained  for  in- 
fants under  1  year  of  age.  Gruel  thick  enough  to  jelly  when  cold 
is  often  called  cereal  jelly. 

Farina  gruel. — One  tablespoon ful  farina,  1  tablespoonful  cold 
water,  |  teaspoonful  salt,  1  cup  boiling  water,  1  cup  scalded  milk. 
Mix  the  farina  with  the  cold  water,  add  to  the  boiling  water,  and  boil 
30  minutes.    Add  the  scalded  milk  and  salt. 

Oatmeal  gi*uel. — One-fourth  cup  coarse  oatmeal,  \  teaspoonful  salt, 
1|  cups  boiling  water,  hot  milk.  Add  the  oatmeal  and  salt  to  the 
boiling  water  and  cook  from  four  to  five  hours  in  a  double  boiler. 
Strain  and  dilute  with  hot  milk  to  the  desired  consistency  either  of 
thin  paste  or  jelly. 

Corn-meat  gruel. — One  tablespoonful  corn  meal,  J  tablespoonful 
flour,  J  teaspoonful  salt,  2  tablespoonfuls  cold  water,  i$  cups  boiling 
water,  milk.  Make  a  smooth  paste  of  the  meal,  flour,  and  salt  with 
the  cold  water  and  stir  into  boiling  water.  Cook  in  a  double  boiler 
one  and  one-half  hours.  Dilute  with  hot  milk  to  the  desired  con- 
sistency of  thin  paste  or  jelly. 

Breakfast  cereals. 

A  double  boiler  or  fireless  cooker  should  be  used.  Have  salted 
boiling  water  in  the  upper  section  of  the  double  boiler  and  place 
directly  on  the  fire.,  Sift  the  dry  ingredients  into  the  water  and 
stir  constantly  to  avoid  lumping.  Boil  from  three  to  five  minutes, 
then  place  the  upper  part  of  the  double  boiler  over  the  lower  part. 
Cover  closely  and  simmer  for  the  time  required  (see  table  on  time 
for  cooking  cereals) ,  or  put  into  a  fireless  cooker  from  10  to  12  hours, 
or  overnight.  Graham  mush  must  be  prepared  like  cereal  water  by 
first  mixing  it  in  cold  water.  Corn  meal  is  best  put  directly  into  cold 
water  in  a  double  boiler  and  cooked  without  stirring. 


INFANT  GAREi-  101 

Proportions  and  time  for  cooking  cereals. 

1  cup  oatmeal 4  cnps  water 3  hours  at  least. 

1  cup  rolled  oats 2  cups  water 1  to  2  hours. 

1  cup  farina 4  cups  water \  to  1  hour. 

1  cup  cracked  wheat 6  cups  water 3  hours  at  least. 

1  cup  graham  flour 3  cups  water \  to  1  hour. 

1  cup  corn  meal 4  cups  water 3  hours. 

1  cup  rice 3  cups  water 50  minutes  if  steamed; 

30  minutes  if  boiled 
after  soaking  over 
night ;  otherwise  \ 
of  an  hour. 

Cereals  are  much  more  appetizing  if  cooked  with  salt.  About  1 
level  teaspoonful  of  salt  should  be  allowed  to  1  cupful  of  dry  cereal. 

All  cereals  used  for  children  need  long  cooking.  If  package  cereals 
are  used,  they  should  be  cooked  for  at  least  twice  the  time  given  in 
the  directions  on  the  wrapper.  Even  those  cereals  which  are  adver- 
tised as  being  partially  cooked  should  be  cooked  for  one  hour  if  they 
are  to  be  served  to  young  children. 

Milk  may  be  substituted  for  half  of  the  water  used  in  cooking 
cereals  and  is  best  added  when  the  cereal  is  partially  or  nearly  done. 
The  food  value  of  the  cereal  is  greatly  increased  by  this  procedure, 
and  the  cereal  is  made  more  appetizing. 

BREADSTUFFS. 
Dried  bread. 

Cut  thin  slices  of  stale  bread  and  place  separately  on  an  oven 
rack  or  on  a  toaster.    Heat  slowly,  so  as  to  dry  without  browning. 
Twice-baked  bread  (zwieback). 

Cut  or  tear  bread  into  small  pieces  and  dry  in  a  slow  oven  until 
thoroughly  but  delicately  browned.  The  warming  oven  of  a  coal 
stove  may  be  used;  if  a  gas  stove  is  used,  the  door  should  be  left 
slightly  open.  Commercial  zwieback  is  usually  sweetened.  Twice- 
baked  bread  may  be  used  in  place  of  cereal,  either  in  slices  or 
crushed. 
Wafers  (plain). 

One  cup  flour,  1  teaspoonful  salt,  1  tablespoonful  butter,  milk. 
Sift  flour  and  salt  together,  chop  in  the  butter,  and  add  enough  milk 
to  make  a  very  stiff  dough ;  chop  thoroughly  and  knead  until  smooth. 
Make  into  small  balls  and  roll  each  one  into  a  thin  wafer.  Place  in 
shallow  greased  and  floured  pans  and  bake  in  a  hot  oven  until  the 
balls  puff  and  are  brown. 

Bran  muffins. 

One  cup  bran,  \  cup  flour,  \  teaspoonful  soda,  2  tablespoonfuls 
butter,  \\  tablespoonfuls  molasses,  f  cup  sour  milk.  Stir  well  and 
bake  in  a  moderate  oven  in  gem  pans. 


102  INFANT    OAKE. 

VEGETABLES. 
Green  vegetables. 

The  most  suitable  ones  for  the  use  of  infants  and  young  children 
are  spinach,  chard,  lettuce,  beet  greens,  beets,  carrots,  turnips,  onions, 
string  beans,  celery  and  asparagus.  Wash  and  prepare  these  vege- 
tables for  cooking.  Divide  them  into  small  pieces ;  boil  slowly  until 
tender  in  soup  stock  or  in  as  little  water  as  possible.  Cook  uncovered 
to  allow  the  escape  of  certain  indigestible  substances.  The  water  in 
which  vegetables  are  cooked  contains  certain  valuable  minerals  and 
should  either  be  served  with  the  vegetable  or  used  in  soup. 

For  infants  these  vegetables  should  be  used  first  as  strained  soup, 
then  as  puree,  and  later  mashed  (jr  finely  divided.  Butter  or  white 
sauce  may  be  added  to  boiled  vegetables  in  the  second  year,  if  de- 
sired. 

Starchy  vegetables. 

White  potato,  rice,  and  macaroni  and  spaghetti  are  usually  classed 
♦as  starchy  vegetables. 

Potato. — When  given  to  infants,  potato  is  best  baked.  Boiled  or 
mashed  potato  may  be  given  to  older  children. 

Rice. — When  used  as  a  vegetable,  rice  should  be  washed  thoroughly 
and  cooked  uncovered  in  considerable  water.  One-half  cup  rice,  4 
cups  water,  \  tea  spoonful  salt.  Do  not  let  water  stop  boiling  when 
rice  is  added.  Boil  45  minutes,  or  until  the  grains  are  tender.  Turn 
into  a  strainer,  drain,  and  set  in  an  oven  a  few  minutes  to  dry.  The 
water  drained  from  rice  prepared  in  this  way  may  be  used  as  a  cereal 
water  or  in  the  preparation  of  vegetable  soup. 

Macaroni  and  spaghetti. — One-half  cup  macaroni,  6  cups  water,  1 
teaspoonful  salt.  Break  macaroni  into  inch  pieces  and  cook  in  boil- 
ing salted  water  from  20  to  30  minutes,  until  the  tubes  begin  to  split 
open.    Strain,  serve  in  soup,  or  with  butter  or  white  sauce. 

Vegetable  soup. 

One  cup  carrots,  1  cup  turnips,  handful  of  spinach  (other  vege- 
tables may  be  substituted) ,  1  teaspoonful  salt,  water  to  cover.  Water 
drained  from  rice  makes  a  more  nourishing  soup  than  plain  water. 
Add  1  soup  bone  or  one-half  cup  scraped  or  chopped  beef  if  desired. 
Chop  vegetables  until  fine  or  put  through  a  meat  grinder.  Cover 
with  water,  using  as  little  as  possible,  and  boil  slowly  until  very 
soft.  For  young  infants,  strain,  pressing  the  vegetables  with  the 
back  of  a  large  spoon.  The  liquid  will  be  cloudy.  For  older  infants 
press  the  vegetables  through  a  sieve,  adding  1  or  more  teaspoonfuls 
of  pulp  to  small  cup  of  liquid. 

When  thus  prepared,  this  soup  may  be  kept  from  three  to  four 
days  except  in  hot  weather,  if  the  entire  quantity  is  heated  to  the 
boiling  point  every  day  before  using. 


INFANT   CARE.  103 

Well-cooked  rice,  barlej^,  or  bread  crumbs  may  be  added  for  in- 
fants. Egg  may  be  given  in  soup,  if  desired,  by  stirring  1  well-beaten 
egg  into  1  cup  of  hot  soup  until  the  egg  becomes  finely  curded. 

MEATS. 
Mutton  broth. 

Two  pounds  mutton  cut  from  fore  quarter,  1  quart  cold  water, 
1  teaspoonful  salt.  Wipe  the  meat,  remove  the  skin  and  fat  and  cut 
into  small  pieces.  Put  in  a  kettle  with  bones  that  have  been  well 
broken.  Add  cold  water  and  let  it  stand  one-half  hour  to  extract 
juices.  Heat  gradually,  uncovered,  to  the  boiling  point  and  skim. 
Simmer  four  hours  or  until  the  meat  is  tender.  Do  not  allow  it  to 
boil.  Add  salt  when  partly  cooked.  Strain,  cool  thoroughly,  and 
remove  all  fat.    Eeheat  the  jelly  as  needed. 

To  increase  the  energy  value  of  the  food,  to  3  ounces  of  this  broth, 
rice,  macaroni,  barley,  egg  yolk,  or  whole  egg  may  be  added. 

Beef  broth  or  chicken  broth  is  prepared  in  the  same  way. 

Scraped  beef. 

Have  a  piece  of  lean  steak  from  \  to  1  inch  thick.  Lay  it  on  a  meat 
board,  and  with  a  large,  heavy  mixing  spoon  scrape  the  soft  part  off 
either  side,  leaving  the  tough  fibers.  Season  the  pulp  with  a  little 
salt  and  shape  into  small  flat  round  cakes  \  inch  thick.  Broil  or  cook 
in  a  hot,  dry  skillet,  never  in  grease.  This  scraped  meat  may  also 
be  served  with  the  addition  of  a  little  butter. 

Beef  juice. 

Select  a  piece  of  meat  from  the  rump  or  upper  part  of  the  round. 
Broil  or  warm  slightly  from  one  to  two  minutes  to  set  free  the  juices. 
Cut  in  small  pieces.  Squeeze  out  the  juice  by  means  of  a  meat  press 
or  potato  ricer.  Feed  the  juice  warm.  One-half  pound  of  steak 
should  furnish  about  2  ounces  of  beef  juice. 

EGGS. 
Coddled  egg. 

In  a  cup  or  a  small  saucepan  boil  1  cupful  of  water  to  1  egg.  Re- 
move pan  from  fire  and  put  in  egg.  Cover  closely  and  allow  to  stand 
6  to  10  minutes,  when  the  whites  should  be  jellied  and  the  yolks 
should  be  soft. 

Scrambled  egg. 

One  egg^  \  cup  milk,  1  teaspoonful  butter,  1  saltspoonful  salt. 
Beat  the  egg  in  the  top  of  a  double  boiler  until  light.  Add  the  milk 
and  other  ingredients.    Stir  over  boiling  water  until  it  thickens. 


104  INFANT   CAKE. 

FRUITS. 
Stewed  prunes. 

Wash  and  look  over  the  prunes,  cover  with  clear,  cold  water  and  let 
them  stand  overnight.  In  the  morning  put  the  saucepan  on  the  back 
of  the  stove  where  the  prunes  will  cook  slowly  for  four  hours.  No 
sugar  is  needed,  as  prunes  are  18  per  cent  sugar  and  are  made  very 
sweet  by  this  manner  of  cooking.  This  simmering  process  renders 
them  rich  and  juicy.  For  infants,  the  prunes  should  be  pressed 
through  a  fine  wire  sieve. 

Apple  sauce. 

Pare  apples,  cut  into  small  pieces,  and  add  to  every  cup  of  apples 
i  cup  of  cold  water.  Cover  and  cook  the  apples  until  tender ;  strain. 
Add  2  tablespoonfuls  of  sugar  to  every  cup  of  strained  apples. 

Baked  apples. 

Wash  and  core  apples.  Put  in  a  shallow  dish  with  1  tablespoonful 
water  to  each  apple ;  more  may  be  added  during  cooking  if  necessary. 
Put  2  teaspoonfuls  of  sugar  into  the  center  of  each  apple.  Bake  in 
a  hot  oven  from  20  to  30  minutes,  or  until  soft ;  baste  with  the  syrup 
every  10  minutes.  For  infants  apples  may  be  pared  before  baking, 
or  the  skin  may  be  removed  after  cooking. 

DESSERTS. 
Plain  junket. 

One  cup  fresh  milk,  J  junket  tablet,  1  teaspoonful  cold  water. 
Heat  milk  until  lukewarm.  Dissolve  the  tablet  in  cold  water  and 
stir  into  the  milk.  Pour  at  once  into  glasses  and  allow  to  stand  one- 
half  hour  in  a  warm  room.    When  firm  set  in  a  cool  place  until  served. 

Custard  junket. 

One-half  cup  hot  milk,  1  egg,  2  tablespoonfuls  sugar,  §  cup  luke- 
warm milk,  J  teaspoonful  vanilla,  \  junket  tablet,  2  teaspoonfuls 
cold  water.  Beat  the  egg,  add  sugar,  pour  on  gradually  the  hot 
milk.  Cook  in  top  of  double  boiler,  stirring  constantly  until  it  thick- 
ens. Take  at  once  from  fire  and  cool.  Dissolve  crushed  tablet  in  cold 
water ;  add  to  lukewarm  milk ;  and  add  to  custard  when  it  is  luke- 
warm, and  blend  thoroughly.  Add  vanilla.  Pour  into  cups.  Allow 
it  to  grow  firm  and  chill. 

Boiled  custard. 

Two  cups  hot  milk,  3  egg  yolks,  J  cup  sugar,  pinch  of  salt,  flavor- 
ing. Beat  the  yolks  slightly  and  add  the  sugar  and  salt.  Pour  the 
hot  milk  over  this  mixture,  stirring  constantly.  Cook  in  a  double 
boiler,  stirring  until  the  mixture  thickens  and  will  form  a  coating  on 
the  spoon.  Cool  and  flavor.  If  the  custard  curdles,  beat  with  an  egg 
beater. 


INFANT  CAKE.  105 

If  the  whites  of  the  eggs  are  to  be  used,  beat  them  Aery  stiff  and 
add  3  tablespoonfuls  of  powdered  sugar.  Place  by  spoonfuls  on 
water  which  is  hot  but  not  boiling.  Cover  the  dish.  Test  occasion- 
ally by  putting  a  knife  into  it ;  when  it  is  done  nothing  will  stick  to 
the  knife.  Remove  from  the  water  with  a  wire  egg  beater  or  split 
spoon  and  place  on  top  of  the  custard. 

Gelatin. 

A  plain  gelatin  made  with  fresh  strained  fruit  juice  (orange)  may 
be  given  to  children.    Artificially  colored  gelatins  are  not  desirable. 

A  snow  pudding  made  of  gelatin  to  which  beaten  white  of  egg  has 
been  added  may  be  used. 

Cornstarch  pudding. 

One  cup  milk,  1}  tablespoons  cornstarch,  1J  tablespoonfuls  sugar, 
pinch  of  salt,  white  of  one  egg,  vanilla.  Scald  the  milk.  Mix  corn- 
starch, sugar,  and  salt  thoroughly;  add  slowly  the  scalded  milk, 
stirring  constantly.  Cook  20  minutes.  Remove  from  fire  and  while 
very  hot  fold  in  lightly  but  thoroughly  the  well-beaten  white  of  egg. 
When  partially  cooled  add  flavoring  to  taste ;  put  into  wet  cups  or 
molds  and  let  stand  for  several  hours  on  ice.  Remove  from  molds. 
May  be  served  with  a  soft  custard.  Vary  the  pudding  by  adding  a 
little  melted  chocolate. 

Cornstarch  fruit  jelly. 

One  pint  fruit  juice,  4  tablespoonfuls  sugar,  1J  cups  cornstarch. 
Sweeten  the  juice  to  taste  and  heat  to  boiling.  Make  a  smooth  paste 
of  the  cornstarch  and  a  little  cold  water,  add  slowly  to  the  juice  and 
cook  30  minutes,  stirring  constantly  at  first.  Pour  into  cold,  wet 
molds.    Serve  cold. 

Rice  pudding. 

One  quart  of  milk,  ^  cupful  of  rice,  J  cupful  of  sugar,  \  teaspoon- 
f ul  of  salt ;  flavoring.  Wash  the  rice  thoroughly,  mix  the  ingredients, 
and  bake  three  hours  or  more  in  a  very  slow  oven,  stirring  occa- 
sionally at  first. 

Prune  whip. 

One-third  pound  prunes,  whites  of  5  eggs,  \  cup  sugar,  \  table- 
spoonful  lemon  juice.  Pick  over  and  wash  prunes,  then  soak  several 
hours  in  cold  water  to  cover ;  cook  in  same  water  until  soft ;  remove 
stones  and  rub  prunes  through  a  strainer,  add  sugar,  and  cook  5 
minutes;  the  mixture  should  be  of  the  consistency  of  marmalade. 
Beat  whites  of  eggs  until  stiff,  add  prune  mixture  gradually  when 
cold,  and  lemon  juice.  Pile  lightly  on  buttered  pudding-dish,  bake 
20  minutes  in  slow  oven.    Serve  cold. 


GOVERNMENT  PUBLICATIONS. 

Much  helpful  and  instructive  literature  concerning  the  health  and 
welfare  of  the  family,  the  care  of  children,  and  the  sanitation  of  the 
home  is  published  by  different  branches  of  the  Federal  Government, 
notably  by  the  various  bureaus  of  the  Department  of  Agriculture, 
by  the  Public  Health  Service  of  the  Treasury  Department,  and  by 
the  Children's  Bureau  of  the  Department  of  Labor. 

Many  of  the  Government  publications  are  distributed  free  of 
charge  to  residents  of  the  United  States.  Some,  however,  have  a 
small  price  attached;  these  may  be  purchased  from  the  Superin- 
tendent of  Documents,  Washington,  D.  C.  Farmers'  Bulletins,  Ento- 
mology Circulars,  Animal  Industry  Circulars,  and  Weekly  News 
Letters  are  to  be  had  by  addressing  a  request  to  the  Secretary  of 
Agriculture ;  and  Public  Health  Reports,  reprints  from  Public  Health 
Reports,  Hygienic  Laboratory  Bulletins,  and  Public  Health  Bul- 
letins, from  the  Public  Health  Service,  Washington,  D.  C.  Publica- 
tions of  the  Children's  Bureau  may  be  secured  upon  application  to 
the  chief  of  the  bureau. 
106 


RECORD  OF  THE  BABY'S  WEIGHT. 


Baby's  name- 
Date  of  birth 


- 

Pounds. 

Ounces. 

Weight  at  birth 

Second  day 

Third  day 

Fourth  dav 

Fifth  dav 

Sixth  day 

Seventh  day 

End  second  week 

End  third  week 

End  fourth  week 

End  fifth  week 

End  sixth  week                          _              

End  seventh  week 

End  eighth  week 

End  ninth  week  _                      _ 

End  eleventh  week 

End  twelfth  week 

End  thirteenth  week 

End  fifteenth  week 

End  seventeenth  week 

End  nineteenth  week              _ 

End  twenty-first  week 

End  twenty-third  week 

End  twenty-fourth  week 

End  seventh  month 

End  ninth  month 

End  eleventh  month 

End  first  year          _             _         _ 

End  eighteenth  month-  _ 

107 


INDEX 


Page. 
Abdominal  bands.    See  Clothing,  selection  of. 
Accidents,  simple  remedies  for: 

Burns 90-91 

Inhaling  foreign  substances 91 

Swallowing  foreign  bodies 90 

Swallowing  pills  or  poison 90 

Adenoids.    See  Diseases,  common. 

Artificial  feeding.    See  Feeding,  artificial.  '"* 

Baby: 

City,  health  centers  for 40-41 

Country,  traveling  clinics  for 41 

Delicate.    See  Baby,  premature. 
Normal  development  of— 
Food  necessary  for— 

From  1  to  2  years 76,79 

Under  1  year 57-58, 71-72, 74-76 

Methods  of  determining 32-33, 54 

Premature,  method  of  caring  for 60-61 

Sick,  careof 79-98 

Symptoms  to  be  noted 79-80 

Baby  from  1  to  2  years: 

Clothing 21,22,23,28-29 

Food 76-79 

Growth 78 

Baby  under  1  year: 

Clothing 18-23,28-29 

Feeding- 
Artificial  feeding,  summary  of 74-76 

Rules 72-73 

Supplementary  diet  to  milk 71-72 

See  also  Feeding,  artificial;  Feeding, 
breast. 
Growth— 

Artificially  fed  infant 73-74 

Breast-fed  infant 53-54 

Baby  pushers.    See  Exercise. 

Bands,  abdominal.   See  Clothing,  selection 

of. 
Bath: 

Directions  for  giving . .' 23-26 

Equipment 16,24 

Kinds  of  bath 25-26 

Overcoming  adversions 25 

Protection  from  drafts 24 

Temperature  of  bath 24, 25-26 

Temperature  of  room 24 

Time 23 

Kinds  of 25-26 

See  also  Nursing  mother,  care  of. 
Bed.    See  Nursery,  furnishings  of. 
Birth  registration: 

Form  for  use  of  parent 2 

Importance  of 11  I 

Requirement  of 11  ' 


Page. 
Bowels: 

During  artificial  feeding 74 

During  nursing  period- 
Baby 56 

Mother 49 

Training  of 42-43,83 

Breadstuffs.    See  Foods,  infant,  recipes  for. 
Breast  feeding.    See  Feeding,  breast. 
Breast  milk.    See  Milk,  breast. 

Breasts,  careof 50-52 

Burns.    See  Accidents. 

Buttermilk  and  whey.    See  Foods,  infant, 

recipes  for. 
Cereals.    See  Foods,  infant,  recipes  for. 
Chafing.    See  Diseases,  common. 
Chicken  pox.    See  Diseases,  communicable. 
Cloaks  and  caps.    See  Clothing,  selection  of. 
Clothing,  selection  of: 
Articles — 

Bands,  abdominal 19-20 

Cloaks  and  caps 22-23 

Diapers 18-19 

Night  clothing 20-21,28-29 

Petticoats 20 

Shirts 20 

Shoes  and  stockings 21-22 

Slips 20 

Factors  to  be  considered- 
Size 34-35 

Style 18 

Weight  according  to — 

Climate 13,17-18,21-22 

Physical  condition  of  baby 17 

Colds.    See  Diseases,  common. 
Colic.    See  Diseases,  common. 
Common  diseases.    See  Diseases,  common. 
Communicable  diseases.    See  Diseases,  com- 
municable. 
Constipation.   See  Diseases,  common. 
Convulsions.   (See  Diseases,  common. 
Creeping  pen.   See  Exercise. 
Croup.   See  Diseases,  common. 
Deciduous  teeth.   See  Teeth,  kinds  of. 
Dedicate  baby.    See  Baby,  premature. 
Desserts.   See  Foods,  infant,  recipes  for. 
Development  of  normal  baby.   See  Baby, 
normal  development  of. 

Diapers,  care  of 18-19 

See  also  Clothing,  selection  of. 
Diarrhea.  See  Diseases,  common. 
Diet  for  the  baby.   See  Feeding,  artificial. 
Diet  for  the  nursing  mother.    See  Nursing 

mother,  care  of. 
Diphtheria.   See  Diseases,  communicable. 

109 


110 


INDEX. 


Page. 
Discipline.    See  Habits,  training,  and  disci- 
pline. 
Diseases: 

Common,  symptoms  and  care  of — 

Adenoids 89 

Chafing 86 

Colds 88 

Colic 82 

Constipation 83-84 

Convulsions 87-88 

Croup 89-90 

Diarrhea 84-85 

Earache 89 

Eczema 86-87 

Enlarged  tonsils 89 

Heat  rash 86 

Hiccough 82 

Hot-weather  disturbances 85 

Rickets 85-86 

Scurvey 85 

Sudden  illness ". 82 

Thrush 87 

Vomiting 82 

Worms 88 

Communicable,  preventing  spread  of 91-93 

Communicable,  symptoms  and  care  of— 

Chicken  pox 95 

Diphtheria 95-96 

German  measles 94 

Gonorrhea 97 

Infantile  paralysis 96 

Measles 93-94 

Scarlet  fever 94 

Smallpox 95 

Syphilis 97-98 

Tuberculosis 97 

Whooping  cough 93 

Dressing  table.    See  Nursery,  furnishings  of. 
Ears: 

Care  of.    See  Special  organs. 
Earache.    See  Diseases,  common. 
Eczema.   See  Diseases, common. 
Eggs.    See  Foods,  infant,  recipes  for. 
Exercise: 

Baby  pushers,  directions  for  making 35 

Clothing  permitting  of  exercise 34-35 

Creeping  pens,  kinds  of 16, 35 

See  also  Nursing  mother,  care  of. 
Expression  of  breast  milk.    See  Milk,  breast, 

expression  of. 
Eyes.    See  Special  organs. 
Feeding: 

Artificial — 

Difficulties  of  the   artificially  fed 
baby- 
Overfeeding  74,  82 

Stools 74 

Underfeeding 74 

Equipment  for 67-68 

From  1  to  2  years 76-79 

Growth  of  infant  receiving 73-74 

Milk  mixtures  according  to  age 69 

Preparation  of  bottle  feedings 68-69 

Rules  for 72-73 


Page. 
Feeding — Continued. 

Artificial— Continued . 

Substitutes  for  mother's  milk 62-65 

Ass's  milk 63 

Cow's  milk,  preparations  of 63-64 

Goat's  milk 62-63 

Proprietary  infant  foods,  care  in 

useof 64-65 

Under  1  year 71-72,74-76 

Breast- 
Care  of  the  nursing  mother 4S-52, 56 

Difficulties  of  nursing  period 55-57 

O  verf  eeding 57, 82 

Stools 56 

Underfeeding 56 

Growth  of  infant  receiving 53-54 

Importance  of 47-48 

Production  of  breast  milk 48 

Rules  for 53 

Substitutes  for.    See  Feeding,  arti- 
ficial. 
Summary    of   feeding    for    a    well 

breast-fed  baby 57-58 

Technique  of  nursing 52-53 

Weaning  from 58-59 

Wet  nurse  for,  selection  of 59-60 

Training  in  food  habits 76 

Feet,  care  of 32 

Foods: 

Energy-producing,  for  baby  from  1  to  2 

years 77-79 

Infant,  recipes  for— 

Breadstuff  s 101 

Buttermilk  and  whey. 99 

Cereals 99-101 

Desserts. ." 104-105 

Eggs 103 

Fruits 104 

Meats 103 

Vegetables 102 

Proprietary  infant.    See  Feeding,  artifi- 
cial; substitutes  for  mother's  milk. 
Fruits.    See  Foods,  infant,  recipes  for. 
Genital  organs.    See  Special  organs. 
Gonorrhea.    See  Diseases,  communicable. 
Growth  of  baby.    See  Baby  from  1  to  2  years. 

See  also  Baby  under  1  year. 
Growth  of  teeth.    See  Teeth,  growth. 
Habits,  training  and  discipline: 
Bad  habits — 

Bed  wotting ^ 45 

Crying ' 44 

Masturbation 45-46 

"  Pacifiers" 44-45 

Thumb  or  finger  sucking 45 

Early  training 46-47,76 

Punishment 46 

Systematic  care 42 

Training  the  bladder 43-44 

Training  the  bowels 42-43, 83 

Training  in  food  habits 76 

Health  centers  for  care  of  the  baby 40-41 

Heat  rash.  See  Diseases,  common. 
Hiccough.  See  Diseases,  common. 
Home,  selection  of 11,12 


INDEX. 


Ill 


Page. 
Hot- weather     disturbances.    See     Diseases, 
common. 

Ice  box,  portable,  for  milk 39-40 

Infantile  paralysis.    See  Diseases,  communi- 
cable. 
Malnutrition: 

Relation  of  improper  food  habits  to 76-77 

Rickets  a  result  of 85-86 

Measles.  See  Diseases,  communicable. 
Meats.  See  Foods,  infant,  recipes  for. 
Milk; 

Breast — 

Conditions  influencing 54-55 

Expression  of,  directions  for 61-62 

Growth  o  f  infant  receiving 53-54, 73 

Cow's— 

Care  in  choice  of 66 

Care  of,  in  home 66-67 

Care  of,  while  traveling 39-40 

Cleanliness  in  production  of 65-66 

Growth  o  f  infant  receiving 73-74 

Preparations  of.    See  Feeding,  arti- 
ficial; substitutes  for  mother's  milk. 

Milk  mixtures  according  to  age 69 

Milk  teeth.    See  Teeth,  kinds  of. 

Mouth.    See  Special  organs. 

Night  clothing.    See  Clothing,  selection  of. 

Nose.    See  Special  organs. 

Nursemaids: 

Children  as  caretakers 38-39 

Selection  and  supervision  of. 38 

Nursery: 

Cleanliness  of 15 

Furnishings  of. 15,16 

Methods  of  heating 13 

Precautions  against  open  windows 36 

Screening  of 36, 39 

Selection  of 12 

Temperature  of 12-13 

Ventilation  of 13-14,28-29 

Nursing  mother,  care  of: 

Baths 49 

Bowels 49,56 

Breasts 50-52 

Diet 48-49 

Fresh  air  and  exercise 50 

Recreation 50 

Sleep 49 

Work 50 

Nutrition.    See  Feeding.    See  also  Malnutri- 
tion. 
Outdoor  life: 

Importance  of 34 

Uses  of  vehicles 35-36 

See  also  Sleeping  porches. 
Overfeeding.    See   Feeding,  artificial,  diffi- 
culties of  the  artificially  fed  baby. 
See  also  Feeding,  breast,  difficulties  of 
nursing  period. 
Petticoats.    See  Clothing,  selection  of. 
Play  pen.    See  Exercise,  creeping  pens. 

Playing  with  the  baby,  moderation  in 37 

Poison,  antidote  for 90 

Portable  refrigerator  for  milk.     See  Ice  box, 
portable. 


Page. 
Premature  baby.    See  Baby,  premature. 
Proprietary  infant  foods.    See  Feeding,  arti- 
ficial—substitutes for  mother's  milk. 

Publications,  Government 106 

Punishment,  danger  in 46,81 

Recipes,  food.    See  Foods,  infant,  recipes  for. 
Recreation.    See  Nursing  mother,  care  of. 
Registration,  birth.    See  Birth  registration. 
Rickets.    See  Diseases,  common. 

Sanitation.    See  Home,  selection  of 12 

Scarlet  fever.    See  Diseases,  communicable. 
Scurvy.    See  Diseases,  common. 

Sea  bathing,  caution  to  be  taken 26 

Shirts.    See  Clothing,  selection  of. 

Shoes  and  stockings.    See  Clothing,  selection 

of. 
Sick  baby.    See  Baby,  sick. 

Sick  room,  care  of 92-93 

Sleep: 

Provisions  for  inducing 28,29-30 

Regularity  in 29-30 

Required  amount 27-28 

See  also  Nursing  mother,  care  of. 
Sleeping  bags.    See   Clothing,  selection  of; 

night  clothing. 
Sleeping  porches: 

Clothing  for 22 

Desirability  of 14, 29, 34 

See  also  Nursery,  ventilation  of. 
Slips.    See  Clothing,  selection  of. 
Smallpox.    See  Diseases,  communicable. 

Special  organs,  care  of 27 

Stools.  See  Feeding,  artificial,  difficulties  of 
the  artificially  fed  baby.  See  also 
Feeding,  breast,  difficulties  of  nursing 
period. 
Substitutes  for  mother's  milk.  See  Feeding, 
artificial. 

Superstitions,  danger  in 41-42 

Syphilis.    See  Diseases,  cornrtmnicable. 
Teeth: 

Care  32 

Growth 31-32 

Kinds 30-31 

Milk  (deciduous) 30-31 

Permanent 30,31 

Thrush.    See  Diseases,  common. 

Toilet,  equipment  for 61 

Tonsils,  enlarged.    See  Diseases,  common. 

Toys,  advisable  kinds  of 37-38 

Training.    See  Habits,  training  and  disci- 
pline. 

Traveling  clinics  for  the  country  baby 41 

Traveling  with  the  baby 39-40 

Care  of  the  diapers 40 

Clothing 40 

Food 39-40 

Portable  ice  box  for  milk 

Tuberculosis.    See  Diseases,  communicable. 
Underfeeding.    See  Feeding,  artificial— diffi- 
culties of  the  artificially  fed  baby. 
See  also  Feeding,  breast,  difficulties 
of  nursing  period. 
Vegetables.    See  Foods,  infant,  recipes  for. 


112 


INDEX. 


Vehicles.    See  Outdoor  life.  Page. 

Ventilation.   See  Nursery,  ventilation  of. 
Vomiting.   See  Diseases,  common. 
Weighing: 

Comparative  results  of  breast-  and  bot- 
tle-fed babies 73-74 


Weighing— Continued.  Page. 

Form  for  use  of  parent 107. 

Method  of 33-34 

Whooping  cough.    See  Diseases,  communi- 
cable. 
Worms.    See  Diseases,  common. 


O 


Owing  to  limited  appropriations  for  printing,  it  is  not  possible 
to  distribute  this  bulletin  in  large  quantities.  Additional  copies 
may  be  procured  from  the  Superintendent  of  Documents,  Govern- 
ment Printing  Office,  Washington,  D.  C,  at  10  cents  per  copy. 


HOME  USE     ' 


^^ISmp|db|l0W 


KM  NO.  DD6,  60m,  aSTS^W^^IWW 

DtKKtLtY,  CA  94720 


®s 


or  to  the 

University  of  California 
Richmond,  CA  94804-4698 

ALL  BOOKS  MAY  BE  RECALLED  AFTER  7  DAYS 
'  brsr,o0aNRLFay  ^  reChar9ed  *  b""9ing 


LXJEASSX^MPED  BELOW 
*  4  2004 


MAYji  2007 


DD20  15M  4-02 


L 


